Healthcare Provider Details

I. General information

NPI: 1083630156
Provider Name (Legal Business Name): HECTOR J GUERRA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/14/2006
Last Update Date: 01/15/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1432 CALLE BARRACUDA BAHIA VISTAMAR
CAROLINA PR
00983-1451
US

IV. Provider business mailing address

1432 CALLE BARRACUDA BAHIA VISTAMAR
CAROLINA PR
00983-1451
US

V. Phone/Fax

Practice location:
  • Phone: 787-768-5501
  • Fax: 787-768-8094
Mailing address:
  • Phone: 787-768-5501
  • Fax: 787-768-8094

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number9140
License Number StatePR
# 3
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State

VIII. Authorized Official

Name: DR. ALICE RUSCALLEDA
Title or Position: CEO
Credential: PH.D.
Phone: 787-768-5501