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General NPI Number Information
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NPI Number | 1992654891
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Entity Type | Organization
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Legal Business Name | NEUROGENESIS CENTRO DE TRATAMIENTO MULTIDISCIPLINARIO, LLC
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Dates
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Enumeration Date | 01/23/2026
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Last Update Date | 01/23/2026
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Provider Practice Location Address
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Address Line | M 133 METRO PLAZA LAS MONJITAS AVE TITO CASTRO 1255 PASEOS LAS MONJITAS
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City | PONCE
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State | PR
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Zip | 00730
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Country | US
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Telephone | 939-630-0860
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Fax |
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Provider Business Mailing Address
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Address Line | URB ESTANCIAS DEL MAYORAL CALLE GUAJANA 12012
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City | VILLALBA
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State | PR
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Zip | 00766-2430
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Country | US
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Telephone | 939-630-0860
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Fax |
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Authorized Official
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Title or Position | CLINICAL PSYCHOLOGIST
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Name | ELVIN SOTO HERNANDEZ
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Credential | MBR
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Telephone | 939-630-0860
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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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