Healthcare Provider Details

I. General information

NPI: 1043769920
Provider Name (Legal Business Name): GLADYVETTE ESTEVEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/03/2016
Last Update Date: 10/03/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

410 AVE HOSTOS STE 7
MAYAGUEZ PR
00682-1500
US

IV. Provider business mailing address

54 CALLE EDUARDO RIERA
MAYAGUEZ PR
00680-3810
US

V. Phone/Fax

Practice location:
  • Phone: 787-833-0663
  • Fax:
Mailing address:
  • Phone: 787-340-3821
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number10511
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: