MEDICARE: MI CUIDADO EMOCIONAL, 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	103TC0700X	Clinical Psychologist

General Provider Information

NPI Number	:	1740069277
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MI CUIDADO EMOCIONAL, LLC

Provider Business Mailing Address
First Line	:	RR 2 BOX 6292
Second Line	:
City	:	MANATI
State	:	PR
Zip	:	00674-9609
Country	:	US
Telephone Number	:	787-373-1284
Fax Number	:

Provider Business Practice Location Address
First Line	:	90 CALLE ALONDRA
Second Line	:	65 INFANTERIA, PLAZA 65 SHOPPING CENTER SUITE 30
City	:	SAN JUAN
State	:	PUERTO RICO
Zip	:	00924-3254
Country	:	UM
Telephone Number	:	787-377-2035
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. ELVIS CANDELARIA SANCHEZ
Credential	:	PSYD
Telephone Number	:	787-373-1284

Provider Enumeration Date	:	09/25/2023
Last Update Date	:	03/17/2024

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