Healthcare Provider Details

I. General information

NPI: 1992497010
Provider Name (Legal Business Name): INNOVA QUIROPRACTICA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/25/2023
Last Update Date: 05/25/2023
Certification Date: 05/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

426 AVE ANDALUCIA
SAN JUAN PR
00920-4114
US

IV. Provider business mailing address

URB HILLSIDE C1 CALLE 2A
SAN JUAN PR
00926
US

V. Phone/Fax

Practice location:
  • Phone: 787-469-7421
  • Fax:
Mailing address:
  • Phone: 787-469-7421
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MISS WALNERIS EDITH PEREZ APONTE
Title or Position: CHIROPRACTOR
Credential: DC
Phone: 787-469-7421