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General NPI Number Information
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NPI Number | 1023561230
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Entity Type | Organization
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Legal Business Name | MENTE ACTIVA
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Dates
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Enumeration Date | 07/25/2016
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Last Update Date | 04/17/2021
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Provider Practice Location Address
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Address Line | 775 CALLE CAOBA CENTRO COMERCIAL LOS CAOBOS, SUITE 10
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City | PONCE
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State | PR
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Zip | 00716-2610
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Country | US
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Telephone | 787-677-0503
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Fax |
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Provider Business Mailing Address
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Address Line | 775 CALLE CAOBA CENTRO COMERCIAL LOS CAOBOS, SUITE 10
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City | PONCE
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State | PR
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Zip | 00716-2610
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Country | US
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Telephone | 787-677-0503
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Fax |
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | DR. JAISSELLE MARIE VEGA
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Credential | PHD
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Telephone | 787-677-0503
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 311500000X
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Taxonomy Name | Alzheimer Center (Dementia Center)
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 103TB0200X
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Taxonomy Name | Cognitive & Behavioral Psychologist
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License Number |
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License Number State |
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