Healthcare Provider Details

I. General information

NPI: 1619632189
Provider Name (Legal Business Name): CENTER FOR ADVANCE COGNITIVE STUDIES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/01/2021
Last Update Date: 11/02/2021
Certification Date: 11/02/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

VILLA CONTESSA EE10 CALLE MARGINAL
BAYAMON PR
00956
US

IV. Provider business mailing address

F1 CALLE 13
BAYAMON PR
00959-4829
US

V. Phone/Fax

Practice location:
  • Phone: 787-533-3996
  • Fax:
Mailing address:
  • Phone: 787-533-3996
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. ASTRID N GANDARILLA
Title or Position: PSYCHOLOGIST
Credential: MSCP, LPC
Phone: 787-533-3996