Provider Demographics
NPI:1326674193
Name:CLINICA DE TERAPIA PINCELADAS DE AMOR
Entity Type:Organization
Organization Name:CLINICA DE TERAPIA PINCELADAS DE AMOR
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:VIVIANA
Authorized Official - Middle Name:MARIA
Authorized Official - Last Name:HERNANDEZ
Authorized Official - Suffix:
Authorized Official - Credentials:SLP
Authorized Official - Phone:787-370-4532
Mailing Address - Street 1:URB EL NARANJAL CALLE 1 F6
Mailing Address - Street 2:
Mailing Address - City:TOA BAJA
Mailing Address - State:PR
Mailing Address - Zip Code:00949-4208
Mailing Address - Country:US
Mailing Address - Phone:787-370-4532
Mailing Address - Fax:
Practice Address - Street 1:H-1 CALLE 6
Practice Address - Street 2:SANTA MONICA
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00957-1825
Practice Address - Country:US
Practice Address - Phone:787-370-4532
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-03-12
Last Update Date:2020-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
No103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty
No224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy AssistantGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR038451900Medicaid
PR4742618OtherIDENTIFICATION NUMBER