Provider Demographics
NPI:1295926657
Name:QUINTANA, MARIA DE LOS ANGELES (PSYD)
Entity type:Individual
Prefix:DR
First Name:MARIA
Middle Name:DE LOS ANGELES
Last Name:QUINTANA
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 1:216 CALLE PINTOR CAMPECHE
Mailing Address - Street 2:URB. BALDRICH
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00918-4316
Mailing Address - Country:US
Mailing Address - Phone:787-612-4747
Mailing Address - Fax:
Practice Address - Street 1:216 CALLE PINTOR CAMPECHE
Practice Address - Street 2:URB. BALDRICH
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00918-4316
Practice Address - Country:US
Practice Address - Phone:787-612-4747
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-09
Last Update Date:2007-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR953103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR953OtherPSICOLOGIST LICENSE