Provider Demographics
NPI:1386261998
Name:SANCHEZ DOMINGUEZ, JESUS ALEJANDRO (PSYD)
Entity type:Individual
Prefix:DR
First Name:JESUS
Middle Name:ALEJANDRO
Last Name:SANCHEZ DOMINGUEZ
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:396 URB. INDUSTRIAL REPARADA 2
Mailing Address - Street 2:396 DR. LUIS F. SALA
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00716-2347
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:396 ZONA IND REPARADA 2
Practice Address - Street 2:DR. LUIS F. SALA
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00716-2347
Practice Address - Country:US
Practice Address - Phone:787-812-2525
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-30
Last Update Date:2022-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
PR7456103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program