Healthcare Provider Details

I. General information

NPI: 1104493790
Provider Name (Legal Business Name): CLINICA HOMEOSTASIS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/10/2021
Last Update Date: 06/10/2021
Certification Date: 06/10/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18 CALLE JOSE ANTONIO FIGUEROA
MAYAGUEZ PR
00680-6802
US

IV. Provider business mailing address

415 CALLE LA LOMA
MAYAGUEZ PR
00680-1484
US

V. Phone/Fax

Practice location:
  • Phone: 501-247-6326
  • Fax:
Mailing address:
  • Phone: 501-247-6326
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code103TF0000X
TaxonomyFamily Psychologist
License Number
License Number State

VIII. Authorized Official

Name: DR. MARTA IVETTE DURAND
Title or Position: PRESIDENT
Credential:
Phone: 501-247-6326