Healthcare Provider Details

I. General information

NPI: 1659644250
Provider Name (Legal Business Name): IFDECH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/14/2012
Last Update Date: 02/14/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

BARRIO CONSEJO BAJO CARRETERA 377 INTERIOR
GUAYANILLA PR
00656-3841
US

IV. Provider business mailing address

PO BOX 560841
GUAYANILLA PR
00656-3841
US

V. Phone/Fax

Practice location:
  • Phone: 787-835-0550
  • Fax:
Mailing address:
  • Phone: 787-835-0550
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP1600X
TaxonomyPastoral Counselor
License NumberTPC-3-15-62-4595
License Number StatePR

VIII. Authorized Official

Name: DR. JAIME GALARZA SIERRA
Title or Position: CONSEJERO PASTORAL
Credential: D. MIN
Phone: 787-835-0550