Healthcare Provider Details

I. General information

NPI: 1811704182
Provider Name (Legal Business Name): JONATHAN XAVIER MATEO SANTIAGO PSYD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/11/2024
Last Update Date: 02/06/2025
Certification Date: 02/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2016 AV. BORINQUEN, CANO MARTIN PENA
SAN JUAN PR
00915
US

IV. Provider business mailing address

HACIENDA LA MONSERRATE #514
MANATI PR
00674
US

V. Phone/Fax

Practice location:
  • Phone: 787-268-4171
  • Fax:
Mailing address:
  • Phone: 787-549-1232
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number8192
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: