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General NPI Number Information
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NPI Number | 1669844338
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Entity Type | Organization
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Legal Business Name | SUI GENERIS CLINICA DE SERVICIOS PSICOLOGICOS P.S.C.
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Dates
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Enumeration Date | 10/21/2015
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Last Update Date | 10/21/2015
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Provider Practice Location Address
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Address Line | 47 CALLE MUNOZ RIVERA
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City | TOAL ALTA
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State | PR
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Zip | 00953
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Country | US
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Telephone | 939-338-1984
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Fax |
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Provider Business Mailing Address
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Address Line | 47 CALLE MUNOZ RIVERA
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City | TOAL ALTA
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State | PR
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Zip | 00953
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Country | US
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Telephone | 939-338-1984
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MISS ANGELA M TABOAS
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Credential |
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Telephone | 787-613-1744
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | 3001
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License Number State | PR
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Taxonomy #2
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Taxonomy Code | 364SX0106X
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Taxonomy Name | Occupational Health Clinical Nurse Specialist
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License Number | 500
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License Number State | PR
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Taxonomy #3
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 3962
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License Number State | PR
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