Healthcare Provider Details

I. General information

NPI: 1639677628
Provider Name (Legal Business Name): TERAPIAS AZUL CELESTE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/25/2018
Last Update Date: 01/25/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CARR. 695 KM 1.6 URB. DORAVILLE BO. HIGUILLAR
DORADO PR
00646
US

IV. Provider business mailing address

URB. SANTA RITA CALLE MARIANA BRACETTI #24 BAJOS
SAN JUAN PR
00925
US

V. Phone/Fax

Practice location:
  • Phone: 787-391-6951
  • Fax:
Mailing address:
  • Phone: 787-391-6951
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State
# 2
Primary TaxonomyY
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: LESLYNETTE RAMOS-IRIZARRY
Title or Position: PRESIDENT
Credential: M.A.
Phone: 787-391-6951