Provider Demographics
NPI:1518113422
Name:GARCIA, HIPOLITA (SICOLOGA)
Entity Type:Individual
Prefix:
First Name:HIPOLITA
Middle Name:
Last Name:GARCIA
Suffix:
Gender:F
Credentials:SICOLOGA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:URB.HILLSIDE 3
Mailing Address - Street 2:F-2
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00926
Mailing Address - Country:US
Mailing Address - Phone:787-756-5779
Mailing Address - Fax:
Practice Address - Street 1:344 AVE AMERICO MIRANDA
Practice Address - Street 2:VILLA NEVAREZ
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00927-5111
Practice Address - Country:US
Practice Address - Phone:787-756-5779
Practice Address - Fax:787-756-5779
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-12
Last Update Date:2008-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR797103T00000X, 103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool