Healthcare Provider Details

I. General information

NPI: 1588220115
Provider Name (Legal Business Name): INSTITUTO COGNOSIS L3C
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/20/2019
Last Update Date: 05/20/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

52 PADIAL ESQUINA CALLE JIMENEZ SICARDO
CAGUAS PR
00725-3555
US

IV. Provider business mailing address

52 CALLE PADIAL
CAGUAS PR
00725-3555
US

V. Phone/Fax

Practice location:
  • Phone: 787-779-9306
  • Fax:
Mailing address:
  • Phone: 787-779-9306
  • 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 Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name: JUAN F RIVERA HERNANDEZ
Title or Position: PRESIDENT
Credential: PHD
Phone: 787-779-9306