Provider Demographics
NPI:1477642577
Name:MAYO-SANTANA, RAUL (PHD)
Entity Type:Individual
Prefix:
First Name:RAUL
Middle Name:
Last Name:MAYO-SANTANA
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:450 AVE DE LA CONSTITUCION
Mailing Address - Street 2:APT. 8E
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00901-2320
Mailing Address - Country:US
Mailing Address - Phone:787-725-2562
Mailing Address - Fax:787-724-4731
Practice Address - Street 1:602 AVE MUNOZ RIVERA
Practice Address - Street 2:SUITE 703
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00918-3608
Practice Address - Country:US
Practice Address - Phone:787-753-2772
Practice Address - Fax:787-724-4731
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR321103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist