Active NPI
Ileana C Surillo, PSY.D
- Clinical Psychologist
- San Juan, PR
National Provider Identifier
1093918369
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 1521
- Practice address
- Ave. Domenech, #400
Suite 507
San Juan, PR 00918 - Phone
- (787) 763-6708
- Fax
- (787) 765-3650
- NPI assigned
- Jun 6, 2007
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | 1521 | PR | Primary |
Addresses
Primary practice location
Ave. Domenech, #400
Suite 507
San Juan, PR 00918
Mailing address
Cond.Panorama Plaza
Apt. 807
San Juan, PR 00926
Phone (787) 344-5337
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1521 | PR | MD | Clinical Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1181088000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1093918369",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "COND.PANORAMA PLAZA",
"address_2": "APT. 807",
"city": "SAN JUAN",
"state": "PR",
"postal_code": "00926",
"telephone_number": "787-344-5337"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "AVE. DOMENECH, #400",
"address_2": "SUITE 507",
"city": "SAN JUAN",
"state": "PR",
"postal_code": "00918",
"telephone_number": "787-763-6708",
"fax_number": "787-765-3650"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SURILLO",
"first_name": "ILEANA",
"middle_name": "C",
"credential": "PSY.D",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-06-06",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "PR",
"license": "1521",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in San Juan, PR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.