Healthcare Provider Details

I. General information

NPI: 1245748284
Provider Name (Legal Business Name): SUENO DE AMOR LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/11/2018
Last Update Date: 01/11/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2613 BLVD LUIS A FERRE
PONCE PR
00717-2106
US

IV. Provider business mailing address

2613 BLVD LUIS A FERRE
PONCE PR
00717-2106
US

V. Phone/Fax

Practice location:
  • Phone: 787-219-8168
  • Fax:
Mailing address:
  • Phone: 787-219-8168
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number594
License Number StatePR
# 2
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number004038
License Number StatePR

VIII. Authorized Official

Name: EDGARDO RODRIGUEZ
Title or Position: ADMINISTRATOR
Credential:
Phone: 787-219-8168