Healthcare Provider Details

I. General information

NPI: 1649194291
Provider Name (Legal Business Name): TRUE SELF FOUNDATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/06/2026
Last Update Date: 08/06/2026
Certification Date: 08/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

386 AVE DOMENECH
SAN JUAN PR
00918-3719
US

IV. Provider business mailing address

386 AVE DOMENECH
SAN JUAN PR
00918-3719
US

V. Phone/Fax

Practice location:
  • Phone: 787-460-3333
  • Fax:
Mailing address:
  • Phone: 787-460-3333
  • 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. MIGUEL VAZQUEZ
Title or Position: EXECUTIVE DIRECTOR
Credential: PSYD
Phone: 787-635-8726