Healthcare Provider Details

I. General information

NPI: 1578117156
Provider Name (Legal Business Name): LOGROS CENTRO DE TRATAMIENTO CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/31/2019
Last Update Date: 07/31/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

AVE. SAN MARCOS #312 URB. EL COMANDANTE
CAROLINA PR
00982
US

IV. Provider business mailing address

AVE. SAN MARCOS #312 URB. EL COMANDANTE
CAROLINA PR
00982
US

V. Phone/Fax

Practice location:
  • Phone: 787-752-1048
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number
License Number State

VIII. Authorized Official

Name: JULIO N BELLO SOTOMAYOR
Title or Position: ADMINISTRATOR
Credential:
Phone: 787-752-1048