Healthcare Provider Details

I. General information

NPI: 1295563955
Provider Name (Legal Business Name): CLINICA DE SERVICIOS INTEGRADOSN ETAPAS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/24/2024
Last Update Date: 07/28/2024
Certification Date: 07/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CARRETERA 123 K. 54.6 INTERIOR BARRIO SALTO ARRIBA, UTUADO
UTUADO PR
00641
US

IV. Provider business mailing address

HC 4 BOX 10014
UTUADO PR
00641-7901
US

V. Phone/Fax

Practice location:
  • Phone: 787-397-7387
  • Fax:
Mailing address:
  • Phone: 787-397-7387
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: MRS. ELENA CUEVAS MONTERO
Title or Position: TRABAJADORA SOCIAL CLINICA
Credential: MSW
Phone: 787-202-0616