Provider Demographics
NPI:1649218793
Name:SANDOVAL CATARINEU, LORELEI MARIE (PSYD)
Entity Type:Individual
Prefix:DR
First Name:LORELEI
Middle Name:MARIE
Last Name:SANDOVAL CATARINEU
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 CALLE CALAF
Mailing Address - Street 2:BOX 100
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00918-1314
Mailing Address - Country:US
Mailing Address - Phone:787-233-8082
Mailing Address - Fax:
Practice Address - Street 1:AUXILIO CENTRO DE CANCER
Practice Address - Street 2:715 AVE. PONCE DE LEON PDA. 37 1/2 CUARTO PISO
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00919
Practice Address - Country:US
Practice Address - Phone:787-233-8082
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-02
Last Update Date:2011-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR2446103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR57287Medicaid