Basic Information
| Provider Information | |||||||||
| NPI: | 1194203000 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DASTA-VALENTIN | ||||||||
| FirstName: | ITZAMAR | ||||||||
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| Credential: | OTR | ||||||||
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| Mailing Information | |||||||||
| Address1: | HC 2 BOX 16371 | ||||||||
| Address2: | |||||||||
| City: | ARECIBO | ||||||||
| State: | PR | ||||||||
| PostalCode: | 006129382 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7872136509 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2 CARR PUERTO RICO 2 | ||||||||
| Address2: | |||||||||
| City: | HATILLO | ||||||||
| State: | PR | ||||||||
| PostalCode: | 00659 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7879153000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/02/2018 | ||||||||
| LastUpdateDate: | 08/02/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225XP0019X | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | Physical Rehabilitation | 225XP0200X | PR | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | Pediatrics | 225X00000X | PR | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist |
No ID Information.