Healthcare Provider Details

I. General information

NPI: 1710758941
Provider Name (Legal Business Name): KRS PSYCHOLOGYS WELLNESS GROUP LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/16/2024
Last Update Date: 01/16/2024
Certification Date: 01/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CARRETERA 132 KM 22.1 BO. CANAS PLAZA GABRIELA
PONCE PR
00728
US

IV. Provider business mailing address

PO BOX 664
MERCEDITA PR
00715-0664
US

V. Phone/Fax

Practice location:
  • Phone: 787-843-9701
  • Fax:
Mailing address:
  • Phone: 787-449-5562
  • 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: DR. KATHIAYARI RODRIGUEZ SILVA
Title or Position: PRESIDENT
Credential: PSYD
Phone: 787-449-5562