Healthcare Provider Details

I. General information

NPI: 1639768435
Provider Name (Legal Business Name): DISCOVERY THERAPY ZONE CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/15/2021
Last Update Date: 01/15/2021
Certification Date: 01/04/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

BO. GUATEMALA CARR 111 KM 16.8 INT
SAN SEBASTIAN PR
00685
US

IV. Provider business mailing address

HC 5 BOX 50202
SAN SEBASTIAN PR
00685-5785
US

V. Phone/Fax

Practice location:
  • Phone: 787-374-2171
  • Fax:
Mailing address:
  • Phone: 787-374-2171
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code2355S0801X
TaxonomySpeech-Language Assistant
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name: CRISTINA MARI QUINTANA BAEZ
Title or Position: PRESIDENT
Credential:
Phone: 787-374-2171