Healthcare Provider Details

I. General information

NPI: 1710361837
Provider Name (Legal Business Name): RESILIENCIAS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/18/2015
Last Update Date: 07/18/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 URB NUEVA 51 URBANIZACION CATALANA
BARCELONETA PR
00617-2518
US

IV. Provider business mailing address

PO BOX 901
BARCELONETA PUERTO RICO
00617
UM

V. Phone/Fax

Practice location:
  • Phone: 787-242-9994
  • Fax:
Mailing address:
  • Phone: 787-242-9994
  • Fax: 787-846-2688

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health (Including Community Mental Health Center)
License Number3602
License Number StatePR

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: DR. LOURDES MORENO-MARTINEZ
Title or Position: CLINICAL PSYCHOLOGIST
Credential: PH.D.
Phone: 787-370-7370