1326470568 NPI number — MRS. VIVIANA DEYA QUINQUILLA PSY.D

Table of content: MRS. VIVIANA DEYA QUINQUILLA PSY.D (NPI 1326470568)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1326470568 NPI number — MRS. VIVIANA DEYA QUINQUILLA PSY.D

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DEYA QUINQUILLA
Provider First Name:
VIVIANA
Provider Middle Name:
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
PSY.D
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1326470568
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/30/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
COND. VENUS TOWER
Provider Second Line Business Mailing Address:
APT. 701 CALLE COSTA RICA 101
Provider Business Mailing Address City Name:
SAN JUAN
Provider Business Mailing Address State Name:
PUERTO RICO
Provider Business Mailing Address Postal Code:
00917
Provider Business Mailing Address Country Code:
UM
Provider Business Mailing Address Telephone Number:
787-210-7163
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
A-1 AVENIDA FERNANDEZ JUNCOS
Provider Second Line Business Practice Location Address:
CAROLINA SHOPPING CENTER
Provider Business Practice Location Address City Name:
CAROLINA
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00984
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-641-0773
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/30/2013

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 103TB0200X , with the licence number:  195030 ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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