Provider Demographics
NPI:1073780581
Name:CUSTOM WELLNESS SOLUTIONS
Entity Type:Organization
Organization Name:CUSTOM WELLNESS SOLUTIONS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:PROF
Authorized Official - First Name:YITZA
Authorized Official - Middle Name:A
Authorized Official - Last Name:ARCELAY
Authorized Official - Suffix:
Authorized Official - Credentials:MPHE, CHES, CLE
Authorized Official - Phone:787-259-1654
Mailing Address - Street 1:1241 BULEVAR SAN LUIS
Mailing Address - Street 2:
Mailing Address - City:COTO LAUREL
Mailing Address - State:PR
Mailing Address - Zip Code:00780-2246
Mailing Address - Country:US
Mailing Address - Phone:787-259-1654
Mailing Address - Fax:787-848-7373
Practice Address - Street 1:CARRETERA 506 KM 0.75
Practice Address - Street 2:EDIFICIO LEGACY OFFICE PARK SUITE 102
Practice Address - City:COTO LAUREL
Practice Address - State:PR
Practice Address - Zip Code:00780-2246
Practice Address - Country:US
Practice Address - Phone:787-259-1654
Practice Address - Fax:787-848-7373
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-14
Last Update Date:2008-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2083P0901XAllopathic & Osteopathic PhysiciansPreventive MedicinePublic Health & General Preventive MedicineGroup - Multi-Specialty
No103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty
No133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, EducationGroup - Multi-Specialty