MEDICARE: ANA SYLVIA GARCIA PASSALACQUA PH. D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC0700X	Clinical Psychologist	1811	PR

General Provider Information

NPI Number	:	1740756410
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANA SYLVIA GARCIA PASSALACQUA PH. D.

Provider Business Mailing Address
First Line	:	CUPEY PROFESSIONAL MALL
Second Line	:	SUITE 206
City	:	SAN JUAN
State	:	PR
Zip	:	00926
Country	:	US
Telephone Number	:	787-504-2111
Fax Number	:

Provider Business Practice Location Address
First Line	:	CUPEY PROFESSIONAL MALL
Second Line	:	SUITE 206
City	:	SAN JUAN
State	:	PR
Zip	:	00926-4257
Country	:	US
Telephone Number	:	787-504-2111
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/19/2018
Last Update Date	:	05/24/2024

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