Provider Demographics
NPI:1669482451
Name:GANDARA, MARIA TERESA (MD)
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:TERESA
Last Name:GANDARA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MARIA
Other - Middle Name:TERESA
Other - Last Name:NAVARRO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:1711 SAN JULIAN STREET
Mailing Address - Street 2:URBANIZACION SAGRADO CORAZON
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00926
Mailing Address - Country:US
Mailing Address - Phone:787-632-7518
Mailing Address - Fax:787-748-2281
Practice Address - Street 1:UNIVERSITY OF PUERTO RICO RIO PIEDRAS
Practice Address - Street 2:MEDICAL SCIENCES CAMPUS PSYCHIATRY DEPARTMENT 9TH FLOOR
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00936-5067
Practice Address - Country:US
Practice Address - Phone:787-766-0940
Practice Address - Fax:787-766-0940
Is Sole Proprietor?:No
Enumeration Date:2006-08-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR51332084P0800X
TXG50732084P0800X
GA0199482084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR29257Medicare ID - Type Unspecified