Provider Demographics
NPI:1376871343
Name:QUINONES- RODRIGUEZ, SALLY (PSYD)
Entity Type:Individual
Prefix:DR
First Name:SALLY
Middle Name:
Last Name:QUINONES- RODRIGUEZ
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:PO BOX 4025
Mailing Address - Street 2:
Mailing Address - City:CAROLINA
Mailing Address - State:PR
Mailing Address - Zip Code:00984-4025
Mailing Address - Country:US
Mailing Address - Phone:787-640-0358
Mailing Address - Fax:
Practice Address - Street 1:1135 65 TH INFANTERIA AVE.
Practice Address - Street 2:ITURREGUI PLAZA 2ND LEVEL SUITE 207
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00924-3489
Practice Address - Country:US
Practice Address - Phone:787-640-0358
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-02
Last Update Date:2016-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR3285103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical