Healthcare Provider Details

I. General information

NPI: 1285348771
Provider Name (Legal Business Name): CENTRO DE TRATAMIENTO INTEGRAL MULTIDISCIPLINARIO INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/09/2023
Last Update Date: 01/09/2023
Certification Date: 01/09/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CARR 119 KM 1.6 AVE. DR. SUSONI
HATILLO PR
00659
US

IV. Provider business mailing address

PO BOX 1122
HATILLO PR
00659-1122
US

V. Phone/Fax

Practice location:
  • Phone: 787-515-5496
  • Fax:
Mailing address:
  • Phone: 787-515-5496
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code2355S0801X
TaxonomySpeech-Language Assistant
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State
# 6
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State

VIII. Authorized Official

Name: DR. LUISITO AGUILAR ABREU
Title or Position: PRESIDENTE
Credential: PSY D
Phone: 787-231-7449