Provider Demographics
NPI:1023561230
Name:MENTE ACTIVA
Entity Type:Organization
Organization Name:MENTE ACTIVA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JAISSELLE
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:VEGA
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:787-677-0503
Mailing Address - Street 1:775 CALLE CAOBA
Mailing Address - Street 2:CENTRO COMERCIAL LOS CAOBOS, SUITE 10
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00716-2610
Mailing Address - Country:US
Mailing Address - Phone:787-677-0503
Mailing Address - Fax:
Practice Address - Street 1:775 CALLE CAOBA
Practice Address - Street 2:CENTRO COMERCIAL LOS CAOBOS, SUITE 10
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00716-2610
Practice Address - Country:US
Practice Address - Phone:787-677-0503
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-25
Last Update Date:2021-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & BehavioralGroup - Multi-Specialty
No311500000XNursing & Custodial Care FacilitiesAlzheimer Center (Dementia Center)Group - Multi-Specialty