Provider Demographics
NPI:1528356722
Name:RONDA, WANDALISSE (MA)
Entity Type:Individual
Prefix:
First Name:WANDALISSE
Middle Name:
Last Name:RONDA
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:340 AVE FELISA RINCON GAUTIER
Mailing Address - Street 2:APT. 2106 PASEO DEL BOSQUE
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00926-6636
Mailing Address - Country:US
Mailing Address - Phone:787-249-1461
Mailing Address - Fax:
Practice Address - Street 1:268 SAN JORGE ST
Practice Address - Street 2:OFIC 101
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00914-6308
Practice Address - Country:US
Practice Address - Phone:787-249-1461
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-07-21
Last Update Date:2011-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1748103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool