Healthcare Provider Details

I. General information

NPI: 1508779513
Provider Name (Legal Business Name): PONCE BRAIN HEALTH INSTITUTE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/23/2026
Last Update Date: 09/23/2026
Certification Date: 09/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

917 AVE TITO CASTRO STE 715
PONCE PR
00716-4717
US

IV. Provider business mailing address

909 AVE TITO CASTRO
PONCE PR
00716-4728
US

V. Phone/Fax

Practice location:
  • Phone: 787-290-5577
  • Fax:
Mailing address:
  • Phone:
  • 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: MONICA RODRIGUEZ VELEZ
Title or Position: PRESIDENT/OWNER
Credential: PSYD
Phone: 787-552-0054