Healthcare Provider Details

I. General information

NPI: 1114779873
Provider Name (Legal Business Name): PSICOLOGIA AMOR & ARTE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/04/2024
Last Update Date: 04/04/2024
Certification Date: 04/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PASEO SAN ISIDRO SUITE #2 CARR.188 KM 2.0 ESQUINA C/6 Y C6A
CANOVANAS PR
00729-0697
US

IV. Provider business mailing address

PO BOX 697
CANOVANAS PR
00729
US

V. Phone/Fax

Practice location:
  • Phone: 787-957-6608
  • Fax:
Mailing address:
  • Phone: 787-368-4614
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number
License Number State

VIII. Authorized Official

Name: DR. LUZ YIRAIDA GONZALEZ RODRIGUEZ
Title or Position: OWNWER/ DIRECTOR
Credential: PHD.
Phone: 787-957-6607