MEDICARE: SUENO DE AMOR LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	235Z00000X	Speech-Language Pathologist	004038	PR
2	225X00000X	Occupational Therapist	594	PR

General Provider Information

NPI Number	:	1245748284
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SUENO DE AMOR LLC

Provider Business Mailing Address
First Line	:	2613 BLVD LUIS A FERRE
Second Line	:
City	:	PONCE
State	:	PR
Zip	:	00717-2106
Country	:	US
Telephone Number	:	787-219-8168
Fax Number	:

Provider Business Practice Location Address
First Line	:	2613 BLVD LUIS A FERRE
Second Line	:
City	:	PONCE
State	:	PR
Zip	:	00717-2106
Country	:	US
Telephone Number	:	787-219-8168
Fax Number	:

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	EDGARDO RODRIGUEZ
Credential	:
Telephone Number	:	787-219-8168

Provider Enumeration Date	:	01/11/2018
Last Update Date	:	01/11/2018

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Directions to “SUENO DE AMOR LLC ” Practice Location

Language	Start Address	Practice Location

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