Provider Demographics
NPI:1740756410
Name:GARCIA PASSALACQUA, ANA SYLVIA (PH D)
Entity type:Individual
Prefix:
First Name:ANA
Middle Name:SYLVIA
Last Name:GARCIA PASSALACQUA
Suffix:
Gender:F
Credentials:PH D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:CUPEY PROFESSIONAL MALL
Mailing Address - Street 2:SUITE 206
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00926
Mailing Address - Country:US
Mailing Address - Phone:787-504-2111
Mailing Address - Fax:
Practice Address - Street 1:CUPEY PROFESSIONAL MALL
Practice Address - Street 2:SUITE 206
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00926-4257
Practice Address - Country:US
Practice Address - Phone:787-504-2111
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-19
Last Update Date:2024-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1811103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical