Healthcare Provider Details

I. General information

NPI: 1023535390
Provider Name (Legal Business Name): CENTRO TERAPEUTICO MULTIDISCIPLINARIO CARI
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/27/2017
Last Update Date: 08/27/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2U5 AVE LAUREL
BAYAMON PR
00956-3340
US

IV. Provider business mailing address

100 CALLE 220 APT 109
CAROLINA PR
00982-2802
US

V. Phone/Fax

Practice location:
  • Phone: 787-233-2747
  • Fax:
Mailing address:
  • Phone: 787-233-2747
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number001677
License Number StatePR
# 2
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number2089
License Number StatePR

VIII. Authorized Official

Name: MR. LUIS MANUEL GONZALEZ
Title or Position: PRESIDENT
Credential: LCDO
Phone: 787-233-2747