=====================================================
General NPI Number Information
=====================================================
NPI Number | 1588993307
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SONALY SIERRA ALICEA PHD
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/08/2009
-----------------------------------------------------
Last Update Date | 01/03/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | B8 AVE LOS VETERANOS URB VILLA ROSA I
-----------------------------------------------------
City | GUAYAMA
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00784
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-669-3629
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 646 ARROYO
-----------------------------------------------------
City | ARROYO
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00714-0646
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-669-3629
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103TC0700X
-----------------------------------------------------
Taxonomy Name | Clinical Psychologist
-----------------------------------------------------
License Number | 3311
-----------------------------------------------------
License Number State | PR
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 103T00000X
-----------------------------------------------------
Taxonomy Name | Psychologist
-----------------------------------------------------
License Number | 3311
-----------------------------------------------------
License Number State | PR
-----------------------------------------------------