Healthcare Provider Details

I. General information

NPI: 1619764495
Provider Name (Legal Business Name): NEURO LAB THERAPY GROUP, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/23/2025
Last Update Date: 04/23/2025
Certification Date: 04/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

825 AVE SAN PATRICIO
SAN JUAN PR
00921-1311
US

IV. Provider business mailing address

825 AVE SAN PATRICIO
SAN JUAN PR
00921-1311
US

V. Phone/Fax

Practice location:
  • Phone: 787-466-9722
  • Fax:
Mailing address:
  • Phone: 787-466-9722
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name: DR. NATASHA TORRES RIVERA
Title or Position: OWNER
Credential: M.S.
Phone: 787-466-9722