Provider Demographics
NPI:1457764243
Name:INTERVENCIONES CREATIVAS
Entity Type:Organization
Organization Name:INTERVENCIONES CREATIVAS
Other - Org Name:INTERVENCIONES CREATIVAS
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:CONSEJERO PROFESIONAL -PROPIETARIO
Authorized Official - Prefix:MS
Authorized Official - First Name:LUIS
Authorized Official - Middle Name:FRANK
Authorized Official - Last Name:GONZALEZ
Authorized Official - Suffix:
Authorized Official - Credentials:PHL
Authorized Official - Phone:787-648-7171
Mailing Address - Street 1:PMB 289-200
Mailing Address - Street 2:AVE. RAFAEL CORDERO
Mailing Address - City:CAGUAS
Mailing Address - State:PR
Mailing Address - Zip Code:00725
Mailing Address - Country:US
Mailing Address - Phone:787-648-7171
Mailing Address - Fax:787-961-6086
Practice Address - Street 1:A-5 CALLE 1 ALTOS
Practice Address - Street 2:URB. CONDADO MODERNO
Practice Address - City:CAGUAS
Practice Address - State:PR
Practice Address - Zip Code:00725
Practice Address - Country:US
Practice Address - Phone:787-648-7171
Practice Address - Fax:787-961-6086
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-09
Last Update Date:2020-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR2294174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR$$$$$$$$$OtherSOCIAL SECURITY