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General NPI Number Information
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NPI Number | 1891518189
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Entity Type | Organization
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Legal Business Name | SERVICIOS PSICOLOGICOS RENUEVATE LLC
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Dates
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Enumeration Date | 11/05/2024
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Last Update Date | 11/05/2024
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Provider Practice Location Address
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Address Line | CARR. 198 KM 22.0 BO. MONTONES I
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City | LAS PIEDRAS
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State | PR
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Zip | 00771-0198
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Country | US
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Telephone | 787-716-0050
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Fax |
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Provider Business Mailing Address
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Address Line | URB. ALTURAS DE SAN BENITO CALLE REINA DE LA PAZ 11
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City | HUMACAO
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State | PR
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Zip | 00791-9202
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Country | US
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Telephone | 787-645-2587
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Fax |
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Authorized Official
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Title or Position | PSY.D.
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Name | DR. BERNARDO ROQUE
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Credential |
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Telephone | 787-645-2587
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number |
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License Number State |
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