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General NPI Number Information
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NPI Number | 1932405255
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Entity Type | Organization
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Legal Business Name | CENTRO HOLISTICO BIENESTAR MENTAL
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Dates
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Enumeration Date | 02/03/2011
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Last Update Date | 05/01/2019
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Provider Practice Location Address
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Address Line | C9 AVE LUIS MUNOZ MARIN
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City | CAGUAS
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State | PR
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Zip | 00725-3330
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Country | US
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Telephone | 787-326-2259
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Fax | 939-204-9060
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Provider Business Mailing Address
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Address Line | PO BOX 547
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City | GURABO
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State | PR
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Zip | 00778-0547
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Country | US
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Telephone | 787-656-3198
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Fax | 787-656-3198
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Authorized Official
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Title or Position | PRESIDENT
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Name | MS. ANISSA V HERNANDEZ
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Credential | MD
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Telephone | 787-326-2259
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 14697
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License Number State | PR
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