Provider Demographics
NPI:1063070621
Name:IRS HOLISTIC CENTER BIENESTAR SALUD Y AUTONOMIA
Entity type:Organization
Organization Name:IRS HOLISTIC CENTER BIENESTAR SALUD Y AUTONOMIA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:IVONNE
Authorized Official - Middle Name:Y
Authorized Official - Last Name:RODRIGUEZ RAMOS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-362-4175
Mailing Address - Street 1:570 EXTENSION VILLAS DE BUENAVENTURA
Mailing Address - Street 2:
Mailing Address - City:YABUCOA
Mailing Address - State:PR
Mailing Address - Zip Code:00767
Mailing Address - Country:US
Mailing Address - Phone:787-362-4175
Mailing Address - Fax:787-767-0210
Practice Address - Street 1:19 CALLE DUFRESNE PUEBLO
Practice Address - Street 2:
Practice Address - City:HUMACAO
Practice Address - State:PR
Practice Address - Zip Code:00791
Practice Address - Country:US
Practice Address - Phone:787-362-4175
Practice Address - Fax:787-767-0210
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-05-30
Last Update Date:2019-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty