Healthcare Provider Details

I. General information

NPI: 1629323712
Provider Name (Legal Business Name): CASA DE TRANSFORMACION Y RESTAURACION FAMILIAR
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/16/2012
Last Update Date: 07/16/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9 PASEO DEL CRISTO
DORADO PR
00646-4999
US

IV. Provider business mailing address

9 PASEO DEL CRISTO
DORADO PR
00646-4999
US

V. Phone/Fax

Practice location:
  • Phone: 787-796-1837
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP1600X
TaxonomyPastoral Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: MARIA I LOPEZ
Title or Position: DIRECTOR
Credential:
Phone: 787-796-1837