Healthcare Provider Details

I. General information

NPI: 1053081729
Provider Name (Legal Business Name): ANEW HEALTH & WELLNESS PSC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/15/2021
Last Update Date: 09/15/2021
Certification Date: 08/26/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1739 CARR 8838 BO MONACILLO CHIRINO OFFICE PLAZA, SUITE 204M
SAN JUAN PR
00926-2745
US

IV. Provider business mailing address

PO BOX 1521
GUAYNABO PR
00970-1521
US

V. Phone/Fax

Practice location:
  • Phone: 787-505-0275
  • Fax:
Mailing address:
  • Phone: 787-668-7872
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. ELENITA VILLEGAS
Title or Position: DIRECTOR
Credential: MD
Phone: 787-668-7872