Healthcare Provider Details

I. General information

NPI: 1760303424
Provider Name (Legal Business Name): IDANARA OCASIO QUINONES PSY.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/21/2026
Last Update Date: 07/21/2026
Certification Date: 07/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1452 AVENUE ASHFORD CONDOMINIUM ADA LIGIA SUITE D
SAN JUAN PR
00907-1581
US

IV. Provider business mailing address

1452 AVENUE ASHFORD CONDOMINIUM ADA LIGIA SUITE D
SAN JUAN PR
00907-1581
US

V. Phone/Fax

Practice location:
  • Phone: 787-346-4172
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number028023
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number8968
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: