Healthcare Provider Details

I. General information

NPI: 1083503254
Provider Name (Legal Business Name): ALEXANDRA ORSINI SANTOS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/01/2025
Last Update Date: 08/04/2025
Certification Date: 08/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

623 AVE. PONCE DE LEON EDIF. BANCO COOP EXECUTIVE TOWER
SAN JUAN PR
00917
US

IV. Provider business mailing address

COND LA ALBORADA 1225 CARR 2 APT 1021
BAYAMON PR
00959
US

V. Phone/Fax

Practice location:
  • Phone: 939-346-1429
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number8479
License Number StatePR
# 2
Primary TaxonomyN
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number8479
License Number StatePR
# 3
Primary TaxonomyN
Taxonomy Code103TF0000X
TaxonomyFamily Psychologist
License Number8479
License Number StatePR
# 4
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number8479
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: