Provider Demographics
NPI:1003954058
Name:QUILES, SANDRA I (PSYCHOLOGIST)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:I
Last Name:QUILES
Suffix:
Gender:F
Credentials:PSYCHOLOGIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:COND CONDADO DEL MAR, AVE ASHFORD 1474
Mailing Address - Street 2:APT 2001
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00907-1538
Mailing Address - Country:US
Mailing Address - Phone:787-449-6863
Mailing Address - Fax:
Practice Address - Street 1:AVE SANTA JUANITA
Practice Address - Street 2:M-70 OFC. #1
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00956
Practice Address - Country:US
Practice Address - Phone:787-449-6863
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-02
Last Update Date:2010-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR432103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical