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General NPI Number Information
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NPI Number | 1275305476
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Entity Type | Organization
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Legal Business Name | PSICOLOGIA INNOVADORA DEL OESTE
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Dates
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Enumeration Date | 10/23/2023
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Last Update Date | 10/23/2023
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Provider Practice Location Address
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Address Line | BO LAVADERO CARR #2 KM HM 165.5
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City | HORMIGUEROS
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State | PR
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Zip | 00660
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Country | US
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Telephone | 939-865-3515
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Fax |
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Provider Business Mailing Address
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Address Line | URB MONTE BELLO 1027 CALLE MAJESTAD
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City | HORMIGUEROS
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State | PR
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Zip | 00660
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Country | US
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Telephone | 939-865-3515
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. GRISSELLE M BEAUCHAMP-CORTES
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Credential | PHD
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Telephone | 787-673-2122
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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