Healthcare Provider Details

I. General information

NPI: 1629495627
Provider Name (Legal Business Name): DESARROLLANDO DESTREZAS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/27/2014
Last Update Date: 03/26/2020
Certification Date: 03/26/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

AVE RAFAEL CORDERO M39 URB CONDADO MODERNO
CAGUAS PR
00725
US

IV. Provider business mailing address

URB ASOMANTE 84 CALLE VIA DEL GUAYABAL
CAGUAS PR
00727-2343
US

V. Phone/Fax

Practice location:
  • Phone: 787-964-4271
  • Fax:
Mailing address:
  • Phone: 787-964-4271
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name: MRS. JARISSEL RODRIGUEZ
Title or Position: OWNER
Credential:
Phone: 787-964-4271