Healthcare Provider Details

I. General information

NPI: 1073478178
Provider Name (Legal Business Name): SARA IVELISSE ALICEA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/20/2025
Last Update Date: 12/20/2025
Certification Date: 12/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

A22 CALLE SALUSTIANO COLON APT B
CAGUAS PR
00725-3966
US

IV. Provider business mailing address

A22 CALLE SALUSTIANO COLON APT B
CAGUAS PR
00725-3966
US

V. Phone/Fax

Practice location:
  • Phone: 787-308-7252
  • Fax:
Mailing address:
  • Phone: 787-308-7252
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number24840
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: