=====================================================
General NPI Number Information
=====================================================
NPI Number | 1740082213
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | NOZOMI INCORPORADO
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/26/2025
-----------------------------------------------------
Last Update Date | 03/26/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | I12 CALLE WILSON
-----------------------------------------------------
City | MAYAGUEZ
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00682-1357
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-322-7994
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 6451
-----------------------------------------------------
City | MAYAGUEZ
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00681-6451
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-322-7994
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT & SECRETARY
-----------------------------------------------------
Name | DR. GABRIELA A. HERNANDEZ BEAUCHAMP
-----------------------------------------------------
Credential | ND
-----------------------------------------------------
Telephone | 787-322-7994
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QH0100X
-----------------------------------------------------
Taxonomy Name | Health Service Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------