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General NPI Number Information
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NPI Number | 1588870349
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Entity Type | Individual
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Provider Name | SANDRA JEAN WIXSON PH.D.
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Gender | Female
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Dates
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Enumeration Date | 05/15/2007
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Last Update Date | 06/02/2009
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Provider Practice Location Address
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Address Line | ROTUNDA 8, CASA # 163 ULLOA
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City | ULLOA
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State | HEREDIA
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Zip | NA
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Country | CR
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Telephone | 1150625890526
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Fax |
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Provider Business Mailing Address
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Address Line | P.O. BOX 025331 SJO 14229
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City | MIAMI
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State | FL
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Zip | 33102
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Country | US
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Telephone | 512-757-1178
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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 | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 23293
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License Number State | TX
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