Provider Demographics
NPI:1174775423
Name:GARCIA-DEL VALLE, ILEANA L (PHD)
Entity type:Individual
Prefix:DR
First Name:ILEANA
Middle Name:L
Last Name:GARCIA-DEL VALLE
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:X5 CALLE PINO
Mailing Address - Street 2:SANTA CLARA DEV.
Mailing Address - City:GUAYNABO
Mailing Address - State:PR
Mailing Address - Zip Code:00969-6838
Mailing Address - Country:US
Mailing Address - Phone:787-717-3122
Mailing Address - Fax:
Practice Address - Street 1:1655 CALLE PARANA
Practice Address - Street 2:RIO PIEDRAS HEIGHTS
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00926-3142
Practice Address - Country:US
Practice Address - Phone:787-633-0169
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-17
Last Update Date:2008-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1282103TC1900X, 103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
No103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool