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General NPI Number Information
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NPI Number | 1780367078
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Entity Type | Organization
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Legal Business Name | CLINICA MENTE GENIAL LLC
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Dates
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Enumeration Date | 08/11/2023
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Last Update Date | 08/21/2023
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Provider Practice Location Address
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Address Line | 7172 AVE. AGUSTIN RAMOS CALERO
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City | ISABELA
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State | PR
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Zip | 00662
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Country | US
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Telephone | 787-599-7722
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Fax |
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Provider Business Mailing Address
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Address Line | URB. SOL Y MAR 508 PASEO CARACOLES
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City | ISABELA
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State | PR
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Zip | 00662
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | SHIRLEY CRUZ ROMERO
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Credential |
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Telephone | 787-599-7722
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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