Provider Demographics
NPI:1164918272
Name:GANDARILLA, ASTRID NOEMI
Entity Type:Individual
Prefix:
First Name:ASTRID
Middle Name:NOEMI
Last Name:GANDARILLA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:F1 CALLE 13
Mailing Address - Street 2:
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00959-4829
Mailing Address - Country:US
Mailing Address - Phone:787-533-3996
Mailing Address - Fax:
Practice Address - Street 1:CALLE MARGINAL EE 10 URB. VILLA CONTESSA
Practice Address - Street 2:LOCAL A 1ER PISO
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00959
Practice Address - Country:US
Practice Address - Phone:939-945-8725
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-02
Last Update Date:2021-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR3759103T00000X
PR2263101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)