Basic Information
| Provider Information | |||||||||
| NPI: | 1417523820 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SILVA | ||||||||
| FirstName: | ADA | ||||||||
| MiddleName: | R | ||||||||
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| Mailing Information | |||||||||
| Address1: | HC 4 BOX 17476 | ||||||||
| Address2: | |||||||||
| City: | CAMUY | ||||||||
| State: | PR | ||||||||
| PostalCode: | 006277633 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7876853202 | ||||||||
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| Practice Location | |||||||||
| Address1: | AVENIDA MUNOZ RIVERA EDIFICIO 309 | ||||||||
| Address2: | BO. PUENTE SECTOR LA ALCANTARILLA | ||||||||
| City: | CAMUY | ||||||||
| State: | PR | ||||||||
| PostalCode: | 00627 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7879153000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/27/2021 | ||||||||
| LastUpdateDate: | 05/27/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 05/18/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 224Z00000X | 118 | PR | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapy Assistant | 224Z00000X | 518 | PR | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapy Assistant |
ID Information
| ID | Type | State | Issuer | Description | 1984225 | 01 | PR | DRIVERS LICENSE | OTHER |