Provider Demographics
NPI:1710364609
Name:SANJURJO, ADELA (TS)
Entity Type:Individual
Prefix:
First Name:ADELA
Middle Name:
Last Name:SANJURJO
Suffix:
Gender:F
Credentials:TS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 52
Mailing Address - Street 2:
Mailing Address - City:LOIZA
Mailing Address - State:PR
Mailing Address - Zip Code:00772-0052
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:CALLE 188 INT 187
Practice Address - Street 2:
Practice Address - City:LOIZA
Practice Address - State:PR
Practice Address - Zip Code:00772
Practice Address - Country:US
Practice Address - Phone:787-876-2042
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-04-30
Last Update Date:2024-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR17533104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker