Provider Demographics
NPI:1295622439
Name:MACHADO ILARRAZA, O'NEILLY
Entity type:Individual
Prefix:
First Name:O'NEILLY
Middle Name:
Last Name:MACHADO ILARRAZA
Suffix:
Gender:F
Credentials:
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 553
Mailing Address - Street 2:
Mailing Address - City:FAJARDO
Mailing Address - State:PR
Mailing Address - Zip Code:00738-0553
Mailing Address - Country:US
Mailing Address - Phone:939-529-8252
Mailing Address - Fax:
Practice Address - Street 1:PO BOX 553
Practice Address - Street 2:
Practice Address - City:FAJARDO
Practice Address - State:PR
Practice Address - Zip Code:00738-0553
Practice Address - Country:US
Practice Address - Phone:939-529-8252
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-06-20
Last Update Date:2025-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR3001103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling