=====================================================
General NPI Number Information
=====================================================
NPI Number | 1720937279
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DUALIDAD CONSCIENTE LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/27/2026
-----------------------------------------------------
Last Update Date | 01/27/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | URB VILLA GRILLASCA A 15 B AVE INTERIOR
-----------------------------------------------------
City | PONCE
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00717
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-677-3398
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 311 CALLE GARDENIA URB LLANOS DEL SUR
-----------------------------------------------------
City | PONCE
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00780-5006
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-677-3398
-----------------------------------------------------
Fax | 787-677-3398
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | AUTHORIZED OFFICIAL
-----------------------------------------------------
Name | LUIS KELIAN HERNANDEZ MUNIZ
-----------------------------------------------------
Credential | PSYD
-----------------------------------------------------
Telephone | 787-677-3398
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103TC0700X
-----------------------------------------------------
Taxonomy Name | Clinical Psychologist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------