=====================================================
General NPI Number Information
=====================================================
NPI Number | 1831082700
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | WELLNESS COLLECTIVE
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/30/2025
-----------------------------------------------------
Last Update Date | 06/03/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1064 AVE PONCE DE LEON STE 205
-----------------------------------------------------
City | SAN JUAN
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00907-3719
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 939-223-7413
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4327 AVE. ISLA VERDE, APT 1205 BEACH TOWER
-----------------------------------------------------
City | CAROLINA
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00979
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-709-6205
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | NATALIA ORTEGA MARTY
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 939-223-7413
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------