Healthcare Provider Details

I. General information

NPI: 1568352748
Provider Name (Legal Business Name): SPEKTRUM GROUP LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/08/2025
Last Update Date: 07/08/2025
Certification Date: 07/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CARRETERA ESTATAL # 5 KM. 28.9 INTERIOR CAMINO LOS NEGRONES BO. GUADIANA
NARANJITO PR
00719
US

IV. Provider business mailing address

HC 71 BOX 3145
NARANJITO PR
00719-9542
US

V. Phone/Fax

Practice location:
  • Phone: 787-908-3122
  • Fax:
Mailing address:
  • Phone: 787-908-3122
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code251300000X
TaxonomyLocal Education Agency (LEA)
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QD1600X
TaxonomyDevelopmental Disabilities Clinic/Center
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. IVANELYSSE ROSA NEGRON
Title or Position: PRESIDENT
Credential: PHD
Phone: 787-908-3122