Healthcare Provider Details

I. General information

NPI: 1902353014
Provider Name (Legal Business Name): INTERCEDE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/07/2016
Last Update Date: 09/07/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

239 SABANETAS IND PK
PONCE PR
00716-4401
US

IV. Provider business mailing address

239 SABANETAS IND PK ACADEMIA PONCE INTER API, 2DO NIVEL
PONCE PR
00716-4401
US

V. Phone/Fax

Practice location:
  • Phone: 939-238-1864
  • Fax:
Mailing address:
  • Phone: 939-238-1864
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TP2701X
TaxonomyGroup Psychotherapy Psychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State
# 7
Primary TaxonomyY
Taxonomy Code2355S0801X
TaxonomySpeech-Language Assistant
License Number
License Number State

VIII. Authorized Official

Name: MISS IVONNE COLON
Title or Position: DIRECTORA
Credential:
Phone: 939-238-1864