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General NPI Number Information
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NPI Number | 1174764815
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Entity Type | Individual
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Provider Name | RAQUEL MARIA SANTALIZ PSY.D
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Gender | Female
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Dates
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Enumeration Date | 03/10/2009
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Last Update Date | 03/23/2016
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Provider Practice Location Address
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Address Line | AA-14 MARGINAL CARR. #3 ALTURAS DE RIO GRANDE
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City | RIO GRANDE
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State | PR
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Zip | 00745
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Country | US
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Telephone | 787-934-1567
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Fax |
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Provider Business Mailing Address
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Address Line | 220 WESTERN AUTO PLAZA SUITE 101 PMB 122
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City | TRUJILLO ALTO
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State | PR
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Zip | 00976
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Country | US
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Telephone | 787-370-9289
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 3307
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License Number State | PR
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