Healthcare Provider Details

I. General information

NPI: 1881239614
Provider Name (Legal Business Name): SENDERO EDUCATIVO, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/15/2019
Last Update Date: 02/03/2020
Certification Date: 02/03/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CANOVANAS MALL ENRIQUE MANGUAL LOCAL #14 CARR. 185 KM. 1.0
CANOVANAS PR
00729
US

IV. Provider business mailing address

CANOVANAS MALL ENRIQUE MANGUAL LOCAL #14 CARR. 185 KM. 1.0
CANOVANAS PR
00729
US

V. Phone/Fax

Practice location:
  • Phone: 787-382-7319
  • Fax:
Mailing address:
  • Phone: 787-382-7319
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TP2701X
TaxonomyGroup Psychotherapy Psychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code224ZE0001X
TaxonomyEnvironmental Modification Occupational Therapy Assistant
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code224ZF0002X
TaxonomyFeeding, Eating & Swallowing Occupational Therapy Assistant
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code224ZL0004X
TaxonomyLow Vision Occupational Therapy Assistant
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name: YARITZA SEMIDEY
Title or Position: PRESIDENTE
Credential:
Phone: 787-382-7319