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General NPI Number Information
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NPI Number | 1649601865
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Entity Type | Organization
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Legal Business Name | ALPES ADVANCED LOGISTIC PSYCHOLOGICAL EDUCATIONAL SERVICES
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Dates
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Enumeration Date | 12/13/2013
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Last Update Date | 01/22/2014
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Provider Practice Location Address
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Address Line | CARR #2 KM 41.3 BO ALGARROBO
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City | VEGA BAJA
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State | PR
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Zip | 00693
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Country | US
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Telephone | 787-403-5644
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Fax |
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Provider Business Mailing Address
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Address Line | 219 CALLE THEBE URB PASEO DEL SOL
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City | DORADO
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State | PR
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Zip | 00646-4668
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Country | US
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Telephone | 787-403-5644
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MARIA OTERO
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Credential | M.D.
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Telephone | 787-403-5644
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Psychologist
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License Number | 4161
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License Number State | PR
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Taxonomy #2
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Taxonomy Code | 103TH0100X
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Taxonomy Name | Health Service Psychologist
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License Number | 4161
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License Number State | PR
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Taxonomy #3
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | 953
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License Number State | PR
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Taxonomy #4
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number | 13642
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License Number State | PR
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Taxonomy #5
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 4161
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License Number State | PR
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