Healthcare Provider Details

I. General information

NPI: 1699565663
Provider Name (Legal Business Name): CENTRO IMEC, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/12/2025
Last Update Date: 05/12/2025
Certification Date: 05/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6 CALLE JOSE DE DIEGO
CIALES PR
00638-3214
US

IV. Provider business mailing address

6 CALLE JOSE DE DIEGO
CIALES PR
00638-3214
US

V. Phone/Fax

Practice location:
  • Phone: 787-562-5261
  • Fax:
Mailing address:
  • Phone: 787-562-5261
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code103TP2701X
TaxonomyGroup Psychotherapy Psychologist
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name: HEISHA RODRIGUEZ RODRIGUEZ
Title or Position: FACTURADORA
Credential:
Phone: 787-562-5261