Healthcare Provider Details

I. General information

NPI: 1265145809
Provider Name (Legal Business Name): PRISCILLA CANCEL OLMO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/28/2022
Last Update Date: 12/28/2022
Certification Date: 12/27/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

AVE 199 LAS CUMBRES CARR. ANTIGUA -845
TRUJILLO ALTO PR
00976
US

IV. Provider business mailing address

HC 71 BOX 7549
CAYEY PR
00736-9791
US

V. Phone/Fax

Practice location:
  • Phone: 787-617-7889
  • Fax:
Mailing address:
  • Phone: 787-617-7889
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number10687
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: