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General NPI Number Information
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NPI Number | 1457764243
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Entity Type | Organization
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Legal Business Name | INTERVENCIONES CREATIVAS
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Dates
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Enumeration Date | 06/09/2014
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Last Update Date | 05/21/2020
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Provider Practice Location Address
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Address Line | A-5 CALLE 1 ALTOS URB. CONDADO MODERNO
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City | CAGUAS
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State | PR
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Zip | 00725
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Country | US
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Telephone | 787-648-7171
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Fax | 787-961-6086
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Provider Business Mailing Address
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Address Line | PMB 289-200 AVE. RAFAEL CORDERO
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City | CAGUAS
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State | PR
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Zip | 00725
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Country | US
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Telephone | 787-648-7171
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Fax | 787-961-6086
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Authorized Official
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Title or Position | CONSEJERO PROFESIONAL -PROPIETARIO
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Name | MS. LUIS FRANK GONZALEZ
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Credential | PHL
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Telephone | 787-648-7171
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 2294
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License Number State | PR
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