Provider Demographics
NPI:1194272575
Name:WELL&LEAN LLC
Entity type:Organization
Organization Name:WELL&LEAN LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:LESLIE
Authorized Official - Middle Name:E
Authorized Official - Last Name:DOMINGUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:787-946-4501
Mailing Address - Street 1:PO BOX 191147
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00919-1147
Mailing Address - Country:US
Mailing Address - Phone:787-946-4501
Mailing Address - Fax:787-946-3501
Practice Address - Street 1:465 AVE HOSTOS
Practice Address - Street 2:URB EL VEDADO
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00918-3014
Practice Address - Country:US
Practice Address - Phone:787-946-4501
Practice Address - Fax:787-946-3501
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-02
Last Update Date:2016-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)