Healthcare Provider Details

I. General information

NPI: 1679343834
Provider Name (Legal Business Name): CENTRO DE TERAPIA JRG INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/08/2024
Last Update Date: 01/08/2024
Certification Date: 01/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

305 CALLE CACERES
SAN JUAN PR
00923-1905
US

IV. Provider business mailing address

305 CALLE CACERES
SAN JUAN PR
00923-1905
US

V. Phone/Fax

Practice location:
  • Phone: 787-756-5779
  • Fax:
Mailing address:
  • Phone: 787-756-5779
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TH0100X
TaxonomyHealth Service Psychologist
License Number
License Number State

VIII. Authorized Official

Name: MISS HIPOLITA GARCIA CRESPO
Title or Position: PRESIDENT
Credential:
Phone: 787-397-7323