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General NPI Number Information
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NPI Number | 1396325106
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Entity Type | Individual
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Provider Name | SIXDALI FERNANDEZ-SANTA PSYD
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Gender | Female
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Dates
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Enumeration Date | 04/14/2021
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Last Update Date | 06/09/2024
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Provider Practice Location Address
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Address Line | CARRETERA 183 KM. 19.2 SECTOR LA ROMANA OFICINA 103
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City | LAS PIEDRAS
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State | PR
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Zip | 00718
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Country | US
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Telephone | 787-435-7238
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Fax |
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Provider Business Mailing Address
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Address Line | HC 20 BOX 28075
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City | SAN LORENZO
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State | PR
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Zip | 00754-9486
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Country | US
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Telephone | 787-559-0098
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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 | 103TC1900X
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Taxonomy Name | Counseling Psychologist
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License Number | 6774
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License Number State | PR
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Taxonomy #2
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 6774
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License Number State | PR
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