Provider Demographics
NPI:1376858431
Name:CET HUELLA DE ANGEL
Entity Type:Organization
Organization Name:CET HUELLA DE ANGEL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:TERAPEUTA OCUPACIONAL
Authorized Official - Prefix:MRS
Authorized Official - First Name:MENDITH
Authorized Official - Middle Name:
Authorized Official - Last Name:GONZALEZ
Authorized Official - Suffix:
Authorized Official - Credentials:TO
Authorized Official - Phone:787-299-5978
Mailing Address - Street 1:ESTANCIAS DE YAUCO C/ALEJANDRINA K8
Mailing Address - Street 2:
Mailing Address - City:YAUCO
Mailing Address - State:PR
Mailing Address - Zip Code:00698
Mailing Address - Country:UM
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:AVE. LOS CASIANO
Practice Address - Street 2:#1
Practice Address - City:YAUCO
Practice Address - State:PR
Practice Address - Zip Code:00698-3434
Practice Address - Country:US
Practice Address - Phone:787-856-3347
Practice Address - Fax:787-856-6197
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-13
Last Update Date:2010-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR842261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center