Provider Demographics
NPI:1396325106
Name:FERNANDEZ-SANTA, SIXDALI (PSYD)
Entity type:Individual
Prefix:
First Name:SIXDALI
Middle Name:
Last Name:FERNANDEZ-SANTA
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:HC 20 BOX 28075
Mailing Address - Street 2:
Mailing Address - City:SAN LORENZO
Mailing Address - State:PR
Mailing Address - Zip Code:00754-9486
Mailing Address - Country:US
Mailing Address - Phone:787-559-0098
Mailing Address - Fax:
Practice Address - Street 1:CARRETERA 183 KM. 19.2 SECTOR LA ROMANA
Practice Address - Street 2:OFICINA 103
Practice Address - City:LAS PIEDRAS
Practice Address - State:PR
Practice Address - Zip Code:00718
Practice Address - Country:US
Practice Address - Phone:787-435-7238
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-14
Last Update Date:2024-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR6774103TC1900X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling