Healthcare Provider Details

I. General information

NPI: 1124933270
Provider Name (Legal Business Name): MINDLINK WELLNESS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/14/2026
Last Update Date: 08/14/2026
Certification Date: 08/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

104 CALLE ATOCHA STE 11
PONCE PR
00730-3772
US

IV. Provider business mailing address

104 CALLE ATOCHA STE 11
PONCE PR
00730-3772
US

V. Phone/Fax

Practice location:
  • Phone: 787-290-9434
  • Fax:
Mailing address:
  • Phone: 787-290-9434
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State

VIII. Authorized Official

Name: GERALINE N VAZQUEZ GONZALEZ
Title or Position: PRESIDENT
Credential: PSYD
Phone: 787-290-9434