Provider Demographics
NPI:1316045024
Name:SANABRIA BURGOS, IVONNE (PSY D)
Entity Type:Individual
Prefix:
First Name:IVONNE
Middle Name:
Last Name:SANABRIA BURGOS
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:CASA LINDA VILLAGE
Mailing Address - Street 2:APT 107
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00959-0000
Mailing Address - Country:US
Mailing Address - Phone:787-297-2917
Mailing Address - Fax:
Practice Address - Street 1:COND CASA LINDA
Practice Address - Street 2:APT 107
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00959-8999
Practice Address - Country:US
Practice Address - Phone:787-297-2917
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2008-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR2301103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical