Healthcare Provider Details

I. General information

NPI: 1144664897
Provider Name (Legal Business Name): ABRAZO DE ANGEL THERAPY GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/24/2013
Last Update Date: 07/09/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CALLE BORI 1528 LOCAL 'A'
SAN JUAN PR
00927-6116
US

IV. Provider business mailing address

CALLE BORI 1528 (MARGINAL CARR. PR-1)
SAN JUAN PR
00927-6116
US

V. Phone/Fax

Practice location:
  • Phone: 787-946-9995
  • Fax:
Mailing address:
  • Phone: 787-946-9995
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number4845804
License Number StatePR

VIII. Authorized Official

Name: MRS. MARANYELIZ IVETTE OLIVERA
Title or Position: CO- OWNER
Credential: OTA
Phone: 787-946-9995