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General NPI Number Information
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NPI Number | 1336468180
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Entity Type | Organization
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Legal Business Name | CENTRO DE EVALUACION, TRATAMIENTOS Y SALUD INTEGRADA
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Dates
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Enumeration Date | 05/19/2010
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Last Update Date | 05/19/2010
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Provider Practice Location Address
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Address Line | CALLE SABANA EXT VALLE ALTO # 2241
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City | PONCE
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State | PR
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Zip | 00730-4143
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Country | US
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Telephone | 787-944-4411
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Fax |
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Provider Business Mailing Address
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Address Line | CALLE SABANA EXT VALLE ALTO # 2241
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City | PONCE
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State | PR
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Zip | 00730-4143
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Country | US
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Telephone | 787-944-4411
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Fax |
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Authorized Official
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Title or Position | PSICOLOGA
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Name | DR. MARIE D ORTIZ EMMANUELLI
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Credential | DOCTORADO
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Telephone | 787-944-4411
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 2578
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License Number State | PR
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