Provider Demographics
NPI: | 1700574787 |
---|---|
Name: | GRILLITOS THERAPY GROUP LLC |
Entity Type: | Organization |
Organization Name: | GRILLITOS THERAPY GROUP LLC |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | PRESIDENT |
Authorized Official - Prefix: | MRS |
Authorized Official - First Name: | LISANGELY |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | RIVERA |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | OTL |
Authorized Official - Phone: | 939-539-4739 |
Mailing Address - Street 1: | PO BOX 194807 |
Mailing Address - Street 2: | |
Mailing Address - City: | SAN JUAN |
Mailing Address - State: | PR |
Mailing Address - Zip Code: | 00919-4807 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 787-378-5366 |
Mailing Address - Fax: | |
Practice Address - Street 1: | CARR. 110 INT. 111 KM. 12.8 |
Practice Address - Street 2: | EDIF. MOCA PROFESSIONAL PLAZA OFIC. 203 |
Practice Address - City: | MOCA |
Practice Address - State: | PR |
Practice Address - Zip Code: | 00676 |
Practice Address - Country: | US |
Practice Address - Phone: | 787-378-5366 |
Practice Address - Fax: | |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2023-04-27 |
Last Update Date: | 2023-04-27 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 225X00000X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | Group - Multi-Specialty | |
No | 103T00000X | Behavioral Health & Social Service Providers | Psychologist | Group - Multi-Specialty | |
No | 103TB0200X | Behavioral Health & Social Service Providers | Psychologist | Cognitive & Behavioral | Group - Multi-Specialty |
No | 103TC0700X | Behavioral Health & Social Service Providers | Psychologist | Clinical | Group - Multi-Specialty |
No | 103TC2200X | Behavioral Health & Social Service Providers | Psychologist | Clinical Child & Adolescent | Group - Multi-Specialty |
No | 103TF0000X | Behavioral Health & Social Service Providers | Psychologist | Family | Group - Multi-Specialty |
No | 103TS0200X | Behavioral Health & Social Service Providers | Psychologist | School | Group - Multi-Specialty |
No | 224Z00000X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapy Assistant | Group - Multi-Specialty | |
No | 225XM0800X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | Mental Health | Group - Multi-Specialty |
No | 225XP0200X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | Pediatrics | Group - Multi-Specialty |
No | 2355S0801X | Speech, Language and Hearing Service Providers | Specialist/Technologist | Speech-Language Assistant | Group - Multi-Specialty |
No | 235Z00000X | Speech, Language and Hearing Service Providers | Speech-Language Pathologist | Group - Multi-Specialty |