Provider Demographics
NPI:1952794182
Name:BRAIN & VISION
Entity Type:Organization
Organization Name:BRAIN & VISION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ROSA
Authorized Official - Middle Name:MARGARITA
Authorized Official - Last Name:HECHAVARRIA
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:939-336-4584
Mailing Address - Street 1:1679 CALLE SANTA TERESA
Mailing Address - Street 2:ALTAMESA
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00921-4731
Mailing Address - Country:US
Mailing Address - Phone:939-336-4584
Mailing Address - Fax:939-336-4584
Practice Address - Street 1:1679 CALLE SANTA TERESA
Practice Address - Street 2:ALTAMESA
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00921-4731
Practice Address - Country:US
Practice Address - Phone:939-336-4584
Practice Address - Fax:939-336-4584
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-12
Last Update Date:2015-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1674261QM1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty