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General NPI Number Information
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NPI Number | 1265668214
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Entity Type | Organization
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Legal Business Name | ASHLEY PROFESSIONAL HOME SERVICES
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Dates
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Enumeration Date | 06/04/2009
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Last Update Date | 06/19/2009
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Provider Practice Location Address
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Address Line | 183 AVE UNIVERSIDAD INTERAMERICA STE 204
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City | SAN GERMAN
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State | PR
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Zip | 00683-4459
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Country | US
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Telephone | 787-892-8868
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Fax |
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Provider Business Mailing Address
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Address Line | 183 AVE UNIVERSIDAD INTERAMERICA STE 204
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City | SAN GERMAN
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State | PR
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Zip | 00683-4459
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Country | US
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Telephone | 787-892-8868
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Fax |
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Authorized Official
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Title or Position | CLINIC DIRECTOR
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Name | MRS. WANDA I MEDINA
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Credential |
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Telephone | 787-892-8868
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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 | 1879
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License Number State | PR
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