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General NPI Number Information
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NPI Number | 1780548834
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Entity Type | Organization
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Legal Business Name | EVOLUTION AND WELLNESS THERAPY GROUP LLC
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Dates
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Enumeration Date | 12/12/2025
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Last Update Date | 12/12/2025
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Provider Practice Location Address
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Address Line | BO. MAMEY, CARR. 4417 KM 0.1
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City | AGUADA
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State | PR
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Zip | 00602
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Country | US
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Telephone | 787-624-9258
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Fax |
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Provider Business Mailing Address
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Address Line | CALL BOX 40000 SUITE 113
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City | AGUADA
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State | PR
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Zip | 00602
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Country | US
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Telephone | 787-624-9258
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Fax |
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Authorized Official
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Title or Position | PRESIDENTE
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Name | MR. EDNIE J RUIZ CARRERO
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Credential | LCSW
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Telephone | 787-624-9258
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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