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General NPI Number Information
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NPI Number | 1275389637
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Entity Type | Organization
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Legal Business Name | DELTA WELLNESS SERVICES
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Dates
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Enumeration Date | 04/26/2024
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Last Update Date | 04/26/2024
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Provider Practice Location Address
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Address Line | 20 CALLE REPARTO PINERO URB PINERO
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City | SAN JUAN
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State | PR
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Zip | 00969-5650
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Country | US
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Telephone | 787-644-4120
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Fax |
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Provider Business Mailing Address
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Address Line | VILLAS DEL PILAR C5 CALLE 2
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City | SAN JUAN
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State | PR
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Zip | 00926-5449
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Country | US
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Telephone | 787-644-4120
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MS. TATIANA M DE LEON RODRIGUEZ
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Credential | PHD
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Telephone | 787-644-4120
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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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