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General NPI Number Information
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NPI Number | 1194139824
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Entity Type | Organization
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Legal Business Name | VIDA INTEGRA DESAROLLANDO ARMONIA (VIDA), LLC
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Dates
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Enumeration Date | 06/20/2014
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Last Update Date | 06/20/2014
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Provider Practice Location Address
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Address Line | URB. MUNOZ RIVERA CALLE ACUARELA 3 KOI BLDG. G-10
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City | GUAYNABO
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State | PR
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Zip | 00969
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Country | US
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Telephone | 787-528-6446
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Fax |
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Provider Business Mailing Address
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Address Line | #46 CALLE 15 PARCELAS HILL BROTHER
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City | SAN JUAN
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State | PR
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Zip | 00924
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Country | US
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Telephone | 787-528-6446
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | KATHIA JAZMIN ROSA
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Credential | MA. PSY.
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Telephone | 787-528-6446
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC1900X
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Taxonomy Name | Counseling Psychologist
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License Number |
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License Number State |
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