Provider Demographics
NPI:1093955882
Name:ALICEA-SANTANA, DIGMARIE ANTONIA (PHD)
Entity Type:Individual
Prefix:DR
First Name:DIGMARIE
Middle Name:ANTONIA
Last Name:ALICEA-SANTANA
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:PO BOX 13
Mailing Address - Street 2:
Mailing Address - City:GARROCHALES
Mailing Address - State:PR
Mailing Address - Zip Code:00652-0013
Mailing Address - Country:US
Mailing Address - Phone:787-413-2965
Mailing Address - Fax:
Practice Address - Street 1:ROAD 2 KM 8.5 BARRIO JUAN SANCHEZ
Practice Address - Street 2:
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00956-0000
Practice Address - Country:US
Practice Address - Phone:787-268-1680
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-06
Last Update Date:2009-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR3075103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical