Provider Demographics
NPI:1477765816
Name:MUJICA, SANDRA MARIA
Entity Type:Individual
Prefix:MRS
First Name:SANDRA
Middle Name:MARIA
Last Name:MUJICA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:476 CALLE CABO H ALVERIO
Mailing Address - Street 2:EXT. ROOSEVELT
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00918-2619
Mailing Address - Country:US
Mailing Address - Phone:787-754-6349
Mailing Address - Fax:787-782-2887
Practice Address - Street 1:476 CALLE CABO H ALVERIO
Practice Address - Street 2:EXT. ROOSEVELT
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00918-2619
Practice Address - Country:US
Practice Address - Phone:787-754-6349
Practice Address - Fax:787-782-2887
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
PR735101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health