Basic Information
| Provider Information | |||||||||
| NPI: | 1689249609 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | DLIS WELLNESS SALUD MENTAL | ||||||||
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| Mailing Information | |||||||||
| Address1: | PARK GARDENS CALLE GETTYSBURG T10 | ||||||||
| Address2: | |||||||||
| City: | SAN JAN | ||||||||
| State: | PR | ||||||||
| PostalCode: | 009262157 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8284897002 | ||||||||
| FaxNumber: | 8285952716 | ||||||||
| Practice Location | |||||||||
| Address1: | PARK GARDENS CALLE GETTYSBURG T10 | ||||||||
| Address2: | |||||||||
| City: | SAN JAN | ||||||||
| State: | PR | ||||||||
| PostalCode: | 009262157 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8284897002 | ||||||||
| FaxNumber: | 8285952716 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/21/2021 | ||||||||
| LastUpdateDate: | 05/21/2021 | ||||||||
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| AuthorizedOfficialLastName: | CORTES-FIGUEROA | ||||||||
| AuthorizedOfficialFirstName: | DAMARIS | ||||||||
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| AuthorizedOfficialTitleorPosition: | COUNSELOR | ||||||||
| AuthorizedOfficialTelephone: | 8284897002 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | LCMHC | ||||||||
| NPICertificationDate: | 05/11/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QM0801X | Y | Ambulatory Health Care Facilities | Clinic/Center | Mental Health (Including Community Mental Health Center) |
No ID Information.