Basic Information
| Provider Information | |||||||||
| NPI: | 1669482451 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GANDARA | ||||||||
| FirstName: | MARIA | ||||||||
| MiddleName: | TERESA | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | NAVARRO | ||||||||
| OtherFirstName: | MARIA | ||||||||
| OtherMiddleName: | TERESA | ||||||||
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| OtherCredential: | MD | ||||||||
| OtherLastNameType: | 5 | ||||||||
| Mailing Information | |||||||||
| Address1: | 1711 SAN JULIAN STREET | ||||||||
| Address2: | URBANIZACION SAGRADO CORAZON | ||||||||
| City: | SAN JUAN | ||||||||
| State: | PR | ||||||||
| PostalCode: | 00926 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7876327518 | ||||||||
| FaxNumber: | 7877482281 | ||||||||
| Practice Location | |||||||||
| Address1: | UNIVERSITY OF PUERTO RICO RIO PIEDRAS | ||||||||
| Address2: | MEDICAL SCIENCES CAMPUS PSYCHIATRY DEPARTMENT 9TH FLOOR | ||||||||
| City: | SAN JUAN | ||||||||
| State: | PR | ||||||||
| PostalCode: | 009365067 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7877660940 | ||||||||
| FaxNumber: | 7877660940 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/08/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084P0800X | 5133 | PR | Y | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry | 2084P0800X | G5073 | TX | N | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry | 2084P0800X | 019948 | GA | N | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry |
No ID Information.