Provider Demographics
NPI:1417160011
Name:FERNANDEZ SISSA, SALVADOR (PH D)
Entity Type:Individual
Prefix:DR
First Name:SALVADOR
Middle Name:
Last Name:FERNANDEZ SISSA
Suffix:
Gender:M
Credentials:PH D
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 299
Mailing Address - Street 2:
Mailing Address - City:LAS PIEDRAS
Mailing Address - State:PR
Mailing Address - Zip Code:00771-0299
Mailing Address - Country:US
Mailing Address - Phone:787-643-9201
Mailing Address - Fax:
Practice Address - Street 1:BO. TEJAS
Practice Address - Street 2:CARR 183 RAMAL 917 KM 0.0
Practice Address - City:LAS PIEDRAS
Practice Address - State:PR
Practice Address - Zip Code:00771-0299
Practice Address - Country:US
Practice Address - Phone:787-643-9201
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-08
Last Update Date:2018-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1342103T00000X
PR3727103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist