Healthcare Provider Details

I. General information

NPI: 1811640816
Provider Name (Legal Business Name): PAULI'S DEVELOPMENT CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/31/2022
Last Update Date: 04/18/2023
Certification Date: 04/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

URB. MARIANI 2961 AVE. ROOSEVELT A-1
PONCE PR
00717-1229
US

IV. Provider business mailing address

MANSIONES DEL LAGO 124 CALLE LAGO CERILLO
COTO LAUREL PR
00780-2485
US

V. Phone/Fax

Practice location:
  • Phone: 787-438-3117
  • Fax:
Mailing address:
  • Phone: 787-438-3117
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code224ZF0002X
TaxonomyFeeding, Eating & Swallowing Occupational Therapy Assistant
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code246Q00000X
TaxonomyPathology Specialist/Technologist
License Number
License Number State
# 6
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name: JACQUELINE N GALARZA LOPEZ
Title or Position: PRESIDENT/DIRECTOR
Credential:
Phone: 787-438-3117