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General NPI Number Information
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NPI Number | 1306207972
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Entity Type | Organization
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Legal Business Name | WELL&LEAN LLC
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Dates
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Enumeration Date | 03/10/2016
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Last Update Date | 06/15/2016
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Provider Practice Location Address
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Address Line | 465 AVE HOSTOS URB VEDADO
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City | SAN JUAN
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State | PR
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Zip | 00918-3014
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Country | US
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Telephone | 787-946-4501
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 191147
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City | SAN JUAN
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State | PR
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Zip | 00919-1147
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Country | US
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Telephone | 787-946-4501
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | LESLIE E DOMINGUEZ
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Credential |
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Telephone | 787-596-0358
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0400X
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Taxonomy Name | Rehabilitation Clinic/Center
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License Number | 2745
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License Number State | PR
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Taxonomy #2
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number | 2745
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License Number State | PR
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