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General NPI Number Information
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NPI Number | 1245120385
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Entity Type | Organization
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Legal Business Name | FUNDACION EDUCATIVA CONCEPCION MARTIN
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Dates
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Enumeration Date | 07/09/2025
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Last Update Date | 07/09/2025
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Provider Practice Location Address
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Address Line | 312 CALLE DIEGO ZALDUONDO
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City | FAJARDO
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State | PR
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Zip | 00738-4758
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Country | US
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Telephone | 787-863-3553
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 70006
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City | FAJARDO
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State | PR
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Zip | 00738-7006
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Country | US
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Telephone | 787-863-3553
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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. IVELISSE MARIE DAVILA
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Credential | ED.DR.
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Telephone | 787-863-3553
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0804X
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Taxonomy Name | Child & Adolescent Psychiatry Physician
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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 | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number |
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License Number State |
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