Healthcare Provider Details

I. General information

NPI: 1316302201
Provider Name (Legal Business Name): PROGRAMA DE SERVICIOS DE SALUD EN EL HOGAR GEMINIS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/21/2015
Last Update Date: 12/21/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CARR 159 # KM13.5
COROZAL PR
00783-2903
US

IV. Provider business mailing address

PO BOX 1144
COROZAL PR
00783-1144
US

V. Phone/Fax

Practice location:
  • Phone: 787-859-5755
  • Fax: 787-859-4307
Mailing address:
  • Phone: 787-859-5755
  • Fax: 787-859-4307

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name: MRS. EMERITA VAZQUEZ LOPEZ
Title or Position: PRESIDENT
Credential:
Phone: 787-859-5755