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General NPI Number Information
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NPI Number | 1114049418
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Entity Type | Organization
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Legal Business Name | R CORDOVA TRABAJADORES SOCIALES CSP
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Dates
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Enumeration Date | 04/06/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | ROAD #2 BAYAMON SHOPPING CENTER SUITE #10E MINI MALL
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City | BAYAMON
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State | PR
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Zip | 00959
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Country | US
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Telephone | 787-798-9097
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Fax | 787-740-2559
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Provider Business Mailing Address
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Address Line | PMB 36 PO BOX 607071
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City | BAYAMON
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State | PR
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Zip | 00960-7071
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Country | US
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Telephone | 787-798-9097
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Fax | 787-740-2559
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Authorized Official
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Title or Position | CHIEF EXECUTIVE OFFICER
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Name | MRS. RITA CORDOVA CAMPOS
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Credential | MSW ACSW
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Telephone | 787-593-0647
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number |
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License Number State |
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