Healthcare Provider Details

I. General information

NPI: 1902344575
Provider Name (Legal Business Name): IBERO AMERICAN ACTION LEAGUE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/03/2017
Last Update Date: 02/11/2020
Certification Date: 02/11/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

817 E MAIN ST
ROCHESTER NY
14605-2722
US

IV. Provider business mailing address

817 E MAIN ST
ROCHESTER NY
14605-2722
US

V. Phone/Fax

Practice location:
  • Phone: 585-256-8900
  • Fax: 585-442-0683
Mailing address:
  • Phone: 585-256-8900
  • Fax: 585-442-0683

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MRS. ANGELICA PEREZ-DELGADO
Title or Position: PRESIDENT & CEO
Credential: CASAC
Phone: 585-256-8900