Healthcare Provider Details

I. General information

NPI: 1093443822
Provider Name (Legal Business Name): ENSENARTE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/10/2022
Last Update Date: 08/10/2022
Certification Date: 08/10/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CARRETERA 8860 KM 1.5 PLAZA MATIENZO SHOPPING CENTER SEGUNDO NIVEL SUITE 3
TRUJILLO ALTO PR
00976
US

IV. Provider business mailing address

18 CALLE TAGORE APT 1911
SAN JUAN PR
00926-4771
US

V. Phone/Fax

Practice location:
  • Phone: 787-550-8735
  • Fax:
Mailing address:
  • Phone: 787-550-8735
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State

VIII. Authorized Official

Name: GISET FIGUEROA LOPEZ
Title or Position: DIRECTOR EJECUTIVO
Credential:
Phone: 787-501-8735