Healthcare Provider Details

I. General information

NPI: 1376938548
Provider Name (Legal Business Name): NEW HEALTH MED GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/03/2015
Last Update Date: 04/03/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

ITURREGUI PLAZA 65 INFANTERIA SUITE 217-A
SAN JUAN PR
00924
US

IV. Provider business mailing address

ITURREGUI PLAZA 65 INFANTERIA SUITE 217-A
SAN JUAN PR
00924
US

V. Phone/Fax

Practice location:
  • Phone: 787-701-2626
  • Fax: 787-768-8094
Mailing address:
  • Phone: 787-701-2626
  • Fax: 787-768-8094

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number11968
License Number StatePR

VIII. Authorized Official

Name: MS. SOPHIA PINEIRO
Title or Position: CEO
Credential: MSW
Phone: 78770126126