Provider Demographics
NPI:1275389637
Name:DELTA WELLNESS SERVICES
Entity Type:Organization
Organization Name:DELTA WELLNESS SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:TATIANA
Authorized Official - Middle Name:M
Authorized Official - Last Name:DE LEON RODRIGUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:787-644-4120
Mailing Address - Street 1:VILLAS DEL PILAR
Mailing Address - Street 2:C5 CALLE 2
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00926-5449
Mailing Address - Country:US
Mailing Address - Phone:787-644-4120
Mailing Address - Fax:
Practice Address - Street 1:20 CALLE REPARTO PINERO
Practice Address - Street 2:URB PINERO
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00969-5650
Practice Address - Country:US
Practice Address - Phone:787-644-4120
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-26
Last Update Date:2024-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty