Healthcare Provider Details

I. General information

NPI: 1760879258
Provider Name (Legal Business Name): HOLISTIC HEALTH GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/22/2015
Last Update Date: 07/30/2022
Certification Date: 07/30/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PORTOBELLO PLAZA SUITE 14
SALINAS PR
00751
US

IV. Provider business mailing address

CALLE JUAN MORALES D 38 URB. VALLE TOLIMA
CAGUAS P.R.
00727
UM

V. Phone/Fax

Practice location:
  • Phone: 787-616-6248
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number11432
License Number StatePR

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: YASMIN NORIEGA
Title or Position: SOCIAL WORKER
Credential: MSW
Phone: 787-616-6248