Provider Demographics
NPI:1811296999
Name:SANTOS, MIGDALIA (PSY-D)
Entity type:Individual
Prefix:
First Name:MIGDALIA
Middle Name:
Last Name:SANTOS
Suffix:
Gender:F
Credentials:PSY-D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:URB LAS BRISCO CALLE 7 M-16
Mailing Address - Street 2:
Mailing Address - City:COROZAL
Mailing Address - State:PR
Mailing Address - Zip Code:00783
Mailing Address - Country:US
Mailing Address - Phone:787-859-5603
Mailing Address - Fax:787-859-7802
Practice Address - Street 1:CARR 159 KILOMETO 15.0 ESQUIRE IDILIO
Practice Address - Street 2:
Practice Address - City:COROZAL
Practice Address - State:PR
Practice Address - Zip Code:00783
Practice Address - Country:US
Practice Address - Phone:787-859-5603
Practice Address - Fax:787-859-7802
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-15
Last Update Date:2011-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR3683103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist