Healthcare Provider Details

I. General information

NPI: 1205753613
Provider Name (Legal Business Name): LILOU ROSE THERAPY CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/06/2026
Last Update Date: 07/07/2026
Certification Date: 07/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

URB VILLA FONTANA PARK 5 X37 CALLE PARQUE DE LA ALIANZA
CAROLINA PR
00983-4532
US

IV. Provider business mailing address

URB VILLA FONTANA PARK CALLE PARQUE DE LA ALIANZA 5X37
CAROLINA PR
00983-4532
US

V. Phone/Fax

Practice location:
  • Phone: 787-470-1004
  • Fax:
Mailing address:
  • Phone: 787-470-1004
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name: MRS. YARIMAR NOEMI HERNANDEZ MARTINEZ
Title or Position: DIRECTOR
Credential:
Phone: 787-470-1004