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General NPI Number Information
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NPI Number | 1497079347
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Entity Type | Organization
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Legal Business Name | MANOS Y VIDA CORP.
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Dates
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Enumeration Date | 03/22/2010
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Last Update Date | 03/22/2010
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Provider Practice Location Address
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Address Line | 76 PARAISO DE GURABO
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City | GURABO
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State | PR
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Zip | 00778-3749
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Country | US
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Telephone | 787-434-4647
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Fax |
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Provider Business Mailing Address
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Address Line | 140 CALLE JOSE DE DIEGO SUITE # 3
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City | CIDRA
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State | PR
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Zip | 00739-3227
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Country | US
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Telephone | 787-434-4647
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Fax |
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Authorized Official
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Title or Position | PSYCHOLOGIST / PRESIDENT
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Name | MR. YAMIL LARA
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Credential |
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Telephone | 787-434-4647
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | 14645
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License Number State | PR
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Taxonomy #2
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 3247
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License Number State | PR
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