Healthcare Provider Details

I. General information

NPI: 1457067704
Provider Name (Legal Business Name): IVANA CAROLINA ESQUILIN SANTOS ATO/L
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/30/2023
Last Update Date: 01/30/2023
Certification Date: 01/23/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

00921 PR-21
SAN JUAN PR
00921
US

IV. Provider business mailing address

URB. BRISAS DE CANOVANAS, CALLE REINITA #17
CANOVANAS PR
00729-3021
US

V. Phone/Fax

Practice location:
  • Phone: 787-766-4646
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number1450
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: