Healthcare Provider Details

I. General information

NPI: 1497079347
Provider Name (Legal Business Name): MANOS Y VIDA CORP.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/22/2010
Last Update Date: 03/22/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

76 PARAISO DE GURABO
GURABO PR
00778-3749
US

IV. Provider business mailing address

140 CALLE JOSE DE DIEGO SUITE # 3
CIDRA PR
00739-3227
US

V. Phone/Fax

Practice location:
  • Phone: 787-434-4647
  • Fax:
Mailing address:
  • Phone: 787-434-4647
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number3247
License Number StatePR
# 2
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number14645
License Number StatePR

VIII. Authorized Official

Name: MR. YAMIL LARA
Title or Position: PSYCHOLOGIST / PRESIDENT
Credential:
Phone: 787-434-4647