Provider Demographics
NPI:1326151911
Name:GRUNDLER, VIRGINIA ALEJANDRA (PSYD)
Entity Type:Individual
Prefix:DR
First Name:VIRGINIA
Middle Name:ALEJANDRA
Last Name:GRUNDLER
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:VETERANS ADMINISTRTION, VETERANS HOSPITAL
Mailing Address - Street 2:10 CASIA ST. MAIL SYMBOL 117
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00926
Mailing Address - Country:US
Mailing Address - Phone:787-531-5360
Mailing Address - Fax:787-641-5716
Practice Address - Street 1:281 AVE WINSTON CHURCHILL
Practice Address - Street 2:SUITE 1
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00926-6654
Practice Address - Country:US
Practice Address - Phone:787-531-5360
Practice Address - Fax:787-641-5716
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1937103TC0700X
IL103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR1937OtherPROFESSIONAL LICENSE