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General NPI Number Information
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NPI Number | 1578288452
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Entity Type | Organization
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Legal Business Name | MIND & SHAPES RESOURCES
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Dates
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Enumeration Date | 10/04/2022
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Last Update Date | 10/04/2022
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Provider Practice Location Address
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Address Line | COBIAN'S PLAZA AVE PONCE DE LEON 1607 SUITE 105
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City | SAN JUAN
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State | PR
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Zip | 00909-0000
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Country | US
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Telephone | 787-445-5000
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Fax |
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Provider Business Mailing Address
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Address Line | 1294 CALLE JUAN BAIZ APDO. 2230
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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 | 787-445-5000
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Fax |
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Authorized Official
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Title or Position | PSYCHOLOGIST
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Name | DR. KIANIVETTE MARTINEZ
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Credential |
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Telephone | 787-445-5000
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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 |
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License Number State |
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