Provider Demographics
NPI:1144655093
Name:SANTOS-VILELLA, FABIOLA (PHD)
Entity type:Individual
Prefix:DR
First Name:FABIOLA
Middle Name:
Last Name:SANTOS-VILELLA
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:561 CALLE ENSENADA
Mailing Address - Street 2:APT. 10-A
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00907-2428
Mailing Address - Country:US
Mailing Address - Phone:787-504-4181
Mailing Address - Fax:787-282-4026
Practice Address - Street 1:561 CALLE ENSENADA
Practice Address - Street 2:APT. 10-A
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00907-2428
Practice Address - Country:US
Practice Address - Phone:787-504-4181
Practice Address - Fax:787-282-4026
Is Sole Proprietor?:No
Enumeration Date:2013-09-11
Last Update Date:2013-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1742103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR1742OtherSTATE LICENCE