Provider Demographics
NPI:1326686742
Name:EMBAJADORA BY INNOVATION INC
Entity Type:Organization
Organization Name:EMBAJADORA BY INNOVATION INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENTA
Authorized Official - Prefix:
Authorized Official - First Name:INGRIS
Authorized Official - Middle Name:
Authorized Official - Last Name:MALDONADO
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:939-655-7983
Mailing Address - Street 1:PO BOX 5127
Mailing Address - Street 2:
Mailing Address - City:CAROLINA
Mailing Address - State:PR
Mailing Address - Zip Code:00984-5127
Mailing Address - Country:US
Mailing Address - Phone:787-518-5720
Mailing Address - Fax:
Practice Address - Street 1:192-14 CALLE 435
Practice Address - Street 2:
Practice Address - City:CAROLINA
Practice Address - State:PR
Practice Address - Zip Code:00985-3013
Practice Address - Country:US
Practice Address - Phone:787-518-5720
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-12-16
Last Update Date:2019-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
No251E00000XAgenciesHome Health
No251S00000XAgenciesCommunity/Behavioral Health
No251T00000XAgenciesProgram of All-Inclusive Care for the Elderly (PACE) Provider Organization
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health