Healthcare Provider Details

I. General information

NPI: 1780547034
Provider Name (Legal Business Name): CENTRO DE BIENESTAR INTEGRAL MINA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/04/2025
Last Update Date: 12/04/2025
Certification Date: 11/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CALLE JUAN R. GARZOT #33 LOCAL # 3
NAGUABO PR
00718
US

IV. Provider business mailing address

BO EL DUQUE BUZON 1961
NAGUABO PR
00718
US

V. Phone/Fax

Practice location:
  • Phone: 787-307-8285
  • Fax:
Mailing address:
  • Phone: 787-307-8285
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: MICHELLE I NAZARIO
Title or Position: MANAGING MEMBER
Credential: MPSY
Phone: 787-307-8285