Provider Demographics
NPI:1760532675
Name:SANCHEZ-LONGO, ISIS MARIA (DRA)
Entity Type:Individual
Prefix:
First Name:ISIS
Middle Name:MARIA
Last Name:SANCHEZ-LONGO
Suffix:
Gender:F
Credentials:DRA
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 270025
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00928-2825
Mailing Address - Country:US
Mailing Address - Phone:787-743-5955
Mailing Address - Fax:787-703-0426
Practice Address - Street 1:URB. SANTA ELVIRA
Practice Address - Street 2:H-18 CALLE SANTA RITA
Practice Address - City:CAGUAS
Practice Address - State:PR
Practice Address - Zip Code:00725
Practice Address - Country:US
Practice Address - Phone:787-743-5955
Practice Address - Fax:787-703-0426
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR76792084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR90807Medicare ID - Type Unspecified
PR90807Medicare UPIN