Healthcare Provider Details

I. General information

NPI: 1871316893
Provider Name (Legal Business Name): CENTRO DE RENOVACION INTEGRAL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/07/2024
Last Update Date: 11/07/2024
Certification Date: 11/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

AVENIDA AGUSTIN RAMOS CALERO INTERIOR CARR 112 KM 1.4
ISABELA PR
00662-0737
US

IV. Provider business mailing address

URB PASEOS REALES 251 CALLE SEGOBIA
AGUADILLA PR
00603
US

V. Phone/Fax

Practice location:
  • Phone: 939-200-7103
  • Fax:
Mailing address:
  • Phone: 939-200-7103
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: JULIO A ADORNO FELICIANO
Title or Position: PRESIDENT/OWNER
Credential: LCDO
Phone: 939-200-7103