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General NPI Number Information
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NPI Number | 1881512382
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Entity Type | Organization
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Legal Business Name | LAVANDA HOLISTIC CLINIC LLC
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Dates
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Enumeration Date | 07/09/2026
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Last Update Date | 07/09/2026
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Provider Practice Location Address
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Address Line | 106 CALLE BAILEN
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City | DORADO
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State | PR
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Zip | 00646-5009
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Country | US
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Telephone | 787-530-1401
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Fax |
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Provider Business Mailing Address
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Address Line | URB QUINTAS DE DORADO V17 CALLE AZAFRAN
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City | DORADO
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State | PR
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Zip | 00646
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Country | US
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Telephone | 787-530-1401
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. KEILY MATOS
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Credential | ND
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Telephone | 787-530-1401
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number |
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License Number State |
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