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General NPI Number Information
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NPI Number | 1366116626
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Entity Type | Organization
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Legal Business Name | RISEUP WELLNESS PR LLC
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Dates
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Enumeration Date | 08/02/2021
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Last Update Date | 09/17/2021
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Provider Practice Location Address
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Address Line | 101 AVE SAN PATRICIO STE 1240
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City | GUAYNABO
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State | PR
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Zip | 00968-3057
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Country | US
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Telephone | 787-512-2058
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Fax |
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Provider Business Mailing Address
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Address Line | 614 VILLA NAVARRA CALLE GARCIA LEDESMA
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City | SAN JUAN
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State | PR
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Zip | 00924
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Country | US
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Telephone | 787-512-2058
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Fax |
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Authorized Official
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Title or Position | CLINICAL PSYCHOLOGIST/ FOUNDER
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Name | DR. FRANCES ENID OSTOLAZA SANTIAGO
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Credential | PHD
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Telephone | 787-512-2058
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TH0100X
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Taxonomy Name | Health Service Psychologist
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License Number |
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License Number State |
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