MEDICARE: MIND & SHAPES RESOURCES

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	103T00000X	Psychologist

General Provider Information

NPI Number	:	1578288452
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MIND & SHAPES RESOURCES

Provider Business Mailing Address
First Line	:	1294 CALLE JUAN BAIZ
Second Line	:	APDO. 2230
City	:	SAN JUAN
State	:	PR
Zip	:	00924
Country	:	US
Telephone Number	:	787-445-5000
Fax Number	:

Provider Business Practice Location Address
First Line	:	COBIAN'S PLAZA AVE PONCE DE LEON 1607
Second Line	:	SUITE 105
City	:	SAN JUAN
State	:	PR
Zip	:	00909-0000
Country	:	US
Telephone Number	:	787-445-5000
Fax Number	:

Authorized Official
Title or Position	:	PSYCHOLOGIST
Name	:	DR. KIANIVETTE MARTINEZ
Credential	:
Telephone Number	:	787-445-5000

Provider Enumeration Date	:	10/04/2022
Last Update Date	:	10/04/2022

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Directions to “MIND & SHAPES RESOURCES ” Practice Location

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