Provider Demographics
NPI:1780252064
Name:GARCIA, GUILLERMO JUAN (PSYD)
Entity type:Individual
Prefix:DR
First Name:GUILLERMO
Middle Name:JUAN
Last Name:GARCIA
Suffix:
Gender:M
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:CALLE TAGORE #18
Mailing Address - Street 2:COND. PARQUES DE CUPEY APTO. 1322
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00926
Mailing Address - Country:US
Mailing Address - Phone:787-565-5320
Mailing Address - Fax:
Practice Address - Street 1:CALLE SARGENTO GERARDO
Practice Address - Street 2:#55 INTERIOR
Practice Address - City:AIBONITO
Practice Address - State:PR
Practice Address - Zip Code:00705
Practice Address - Country:US
Practice Address - Phone:787-714-2462
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-14
Last Update Date:2021-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR6646103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical