Healthcare Provider Details

I. General information

NPI: 1407106586
Provider Name (Legal Business Name): CENTRO C.I.E.H.L.O.INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/15/2012
Last Update Date: 09/15/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

A-49 CALLE MARGINAL URB. BARALT
FAJARDO PUERTO RICO
00738
AL

IV. Provider business mailing address

A49 CALLE MARGINAL URB. BARALT
FAJARDO PR
00738-3759
US

V. Phone/Fax

Practice location:
  • Phone: 787-801-2966
  • Fax:
Mailing address:
  • Phone: 787-801-2966
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number3991
License Number StatePR
# 2
Primary TaxonomyN
Taxonomy Code261QX0100X
TaxonomyOccupational Medicine Clinic/Center
License Number1097
License Number StatePR
# 3
Primary TaxonomyY
Taxonomy Code261QH0700X
TaxonomyHearing and Speech Clinic/Center
License Number908
License Number StatePR

VIII. Authorized Official

Name: DR. IVELISSE PINERO
Title or Position: DIRECTOR
Credential: MS,SLP
Phone: 787-692-2422