Provider Demographics
NPI:1932170818
Name:SANCHEZ, CORALIS (PSYD)
Entity Type:Individual
Prefix:
First Name:CORALIS
Middle Name:
Last Name:SANCHEZ
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:PO BOX 334
Mailing Address - Street 2:
Mailing Address - City:ENSENADA
Mailing Address - State:PR
Mailing Address - Zip Code:00647-0334
Mailing Address - Country:US
Mailing Address - Phone:787-608-5663
Mailing Address - Fax:787-821-3557
Practice Address - Street 1:BARRIO COLOMBIA CALLE RELAMPAGO #70
Practice Address - Street 2:EDIFICIO CENTRO DEL OESTE, SUITE 104
Practice Address - City:MAYAGUEZ
Practice Address - State:PR
Practice Address - Zip Code:00680
Practice Address - Country:US
Practice Address - Phone:787-608-5663
Practice Address - Fax:787-821-3557
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR2599103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist