Healthcare Provider Details

I. General information

NPI: 1881512382
Provider Name (Legal Business Name): LAVANDA HOLISTIC CLINIC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/09/2026
Last Update Date: 07/09/2026
Certification Date: 07/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

106 CALLE BAILEN
DORADO PR
00646-5009
US

IV. Provider business mailing address

URB QUINTAS DE DORADO V17 CALLE AZAFRAN
DORADO PR
00646
US

V. Phone/Fax

Practice location:
  • Phone: 787-530-1401
  • Fax:
Mailing address:
  • Phone: 787-530-1401
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. KEILY MATOS
Title or Position: OWNER
Credential: ND
Phone: 787-530-1401