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General NPI Number Information
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NPI Number | 1669344115
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Entity Type | Organization
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Legal Business Name | BLUEMIND LLC
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Dates
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Enumeration Date | 09/23/2025
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Last Update Date | 09/23/2025
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Provider Practice Location Address
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Address Line | URB. INDUSTRIAL REPARADA 2188 LOCAL A SUITE A PONCE BY PASS
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City | PONCE
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State | PR
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Zip | 00716-0000
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Country | US
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Telephone | 787-223-2029
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Fax |
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Provider Business Mailing Address
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Address Line | 2188 PONCE BYP
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City | PONCE
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State | PR
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Zip | 00716-0315
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Country | US
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Telephone | 787-504-1146
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Fax |
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Authorized Official
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Title or Position | PRESIDENT / OWNER
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Name | RICARDO JAVIER VERA
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Credential |
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Telephone | 787-504-1146
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number |
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License Number State |
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