=====================================================
General NPI Number Information
=====================================================
NPI Number | 1699565663
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CENTRO IMEC, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/12/2025
-----------------------------------------------------
Last Update Date | 05/12/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6 CALLE JOSE DE DIEGO
-----------------------------------------------------
City | CIALES
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00638-3214
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-562-5261
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6 CALLE JOSE DE DIEGO
-----------------------------------------------------
City | CIALES
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00638-3214
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-562-5261
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | FACTURADORA
-----------------------------------------------------
Name | HEISHA RODRIGUEZ RODRIGUEZ
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 787-562-5261
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103TS0200X
-----------------------------------------------------
Taxonomy Name | School Psychologist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 225X00000X
-----------------------------------------------------
Taxonomy Name | Occupational Therapist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 103TP2701X
-----------------------------------------------------
Taxonomy Name | Group Psychotherapy Psychologist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #4
-----------------------------------------------------
Taxonomy Code | 235Z00000X
-----------------------------------------------------
Taxonomy Name | Speech-Language Pathologist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------