Individual
ILEANA DOMENECH-DE LA ROSA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PSYD
Contact information
Practice address
CONDOMINIO PARQUE CENTRO, APT L15, SAN JUAN, PR 00918
(787) 688-4664
Mailing address
PO BOX 190100, SAN JUAN, PR 00919-0100
(787) 688-4664
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
5919
PR
Other
Enumeration date
09/13/2018
Last updated
09/13/2018
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