Healthcare Provider Details

I. General information

NPI: 1013482066
Provider Name (Legal Business Name): CONDADO WELLNESS CENTER PSC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/05/2018
Last Update Date: 03/14/2025
Certification Date: 03/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 CALLE DE DIEGO
SAN JUAN PR
00925-3406
US

IV. Provider business mailing address

100 PASEO SAN PABLO STE 503
BAYAMON PR
00961-7028
US

V. Phone/Fax

Practice location:
  • Phone: 787-230-7557
  • Fax:
Mailing address:
  • Phone: 787-230-7557
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code173C00000X
TaxonomyReflexologist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number
License Number State
# 6
Primary TaxonomyY
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. ALFREDO AYALA
Title or Position: PRESIDENT
Credential:
Phone: 787-230-7557