Provider Demographics
NPI:1326470568
Name:DEYA QUINQUILLA, VIVIANA (PSYD)
Entity Type:Individual
Prefix:MRS
First Name:VIVIANA
Middle Name:
Last Name:DEYA QUINQUILLA
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:COND. VENUS TOWER
Mailing Address - Street 2:APT. 701 CALLE COSTA RICA 101
Mailing Address - City:SAN JUAN
Mailing Address - State:PUERTO RICO
Mailing Address - Zip Code:00917
Mailing Address - Country:UM
Mailing Address - Phone:787-210-7163
Mailing Address - Fax:
Practice Address - Street 1:A-1 AVENIDA FERNANDEZ JUNCOS
Practice Address - Street 2:CAROLINA SHOPPING CENTER
Practice Address - City:CAROLINA
Practice Address - State:PR
Practice Address - Zip Code:00984
Practice Address - Country:US
Practice Address - Phone:787-641-0773
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-07-30
Last Update Date:2013-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
195030103TB0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral