Healthcare Provider Details

I. General information

NPI: 1366116626
Provider Name (Legal Business Name): RISEUP WELLNESS PR LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/02/2021
Last Update Date: 09/17/2021
Certification Date: 09/17/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 AVE SAN PATRICIO STE 1240
GUAYNABO PR
00968-3057
US

IV. Provider business mailing address

614 VILLA NAVARRA CALLE GARCIA LEDESMA
SAN JUAN PR
00924
US

V. Phone/Fax

Practice location:
  • Phone: 787-512-2058
  • Fax:
Mailing address:
  • Phone: 787-512-2058
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TH0100X
TaxonomyHealth Service Psychologist
License Number
License Number State

VIII. Authorized Official

Name: DR. FRANCES ENID OSTOLAZA SANTIAGO
Title or Position: CLINICAL PSYCHOLOGIST/ FOUNDER
Credential: PHD
Phone: 787-512-2058