Healthcare Provider Details

I. General information

NPI: 1982447223
Provider Name (Legal Business Name): CENTRO DE APOYO INTEGRADO Y KINESIOLOGIA ENERGETICA INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/14/2024
Last Update Date: 01/29/2025
Certification Date: 01/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CONDOMINIO DARLINGTON 1007 AVE. MUNOZ RIVERA, SUITE 1200
SAN JUAN PR
00925-2726
US

IV. Provider business mailing address

COND DARLINGTON 1007 AVE. MUNOZ RIVERA, SUITE 1201
SAN JUAN PR
00925-2726
US

V. Phone/Fax

Practice location:
  • Phone: 787-930-9942
  • Fax:
Mailing address:
  • Phone: 787-930-9942
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code133NN1002X
TaxonomyNutrition Education Nutritionist
License Number
License Number State

VIII. Authorized Official

Name: DR. WANDA PACHECO BOU
Title or Position: EXECUTIVE DIRECTOR
Credential: PHD
Phone: 787-633-1382