Healthcare Provider Details

I. General information

NPI: 1386575512
Provider Name (Legal Business Name): NOVAMENTE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/27/2026
Last Update Date: 05/27/2026
Certification Date: 05/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

420 AVE PONCE DE LEON STE 701
SAN JUAN PR
00918-3407
US

IV. Provider business mailing address

420 AVE PONCE DE LEON STE 701
SAN JUAN PR
00918-3407
US

V. Phone/Fax

Practice location:
  • Phone: 787-765-5678
  • Fax:
Mailing address:
  • Phone: 787-765-5678
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State

VIII. Authorized Official

Name: DR. AGUSTIN ESTRONZA
Title or Position: CLINICAL PSYCHOLOGIST
Credential: PSYD
Phone: 787-765-5678