MEDICARE: INSTITUTO MODELO DE ENSENANZA INDIVIDUALIZADA

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	224Z00000X	Occupational Therapy Assistant

General Provider Information

NPI Number	:	1497545347
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	INSTITUTO MODELO DE ENSENANZA INDIVIDUALIZADA

Provider Business Mailing Address
First Line	:	PO BOX 21307
Second Line	:
City	:	SAN JUAN
State	:	PR
Zip	:	00928-1307
Country	:	US
Telephone Number	:	787-758-0535
Fax Number	:

Provider Business Practice Location Address
First Line	:	211 CALLE ARIZMENDI
Second Line	:
City	:	SAN JUAN
State	:	PR
Zip	:	00925-3408
Country	:	US
Telephone Number	:	787-758-0535
Fax Number	:

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR ASSISTANT
Name	:	MARIA DEL PILAR SOTO
Credential	:
Telephone Number	:	787-758-0535

Provider Enumeration Date	:	05/12/2025
Last Update Date	:	05/12/2025

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