Organization
ECOSALUS
Active
Other names
EcoSalus
Organization subpart
No
Provider details
NPI number
Authorized official
LESLIE E DOMINGUEZ M.A (SOLE PROPIETOR)
(787) 596-0358
Entity
Organization
Contact information
Practice address
274 LIRIO, SAN RAFAEL ESTATES II, BAYAMON, PR 00959
(787) 596-0358
Mailing address
274 CALLE LIRIO, BAYAMON, PR 00959-4181
(787) 596-0358
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
—
—
103TE1100X
Exercise & Sports Psychologist
—
—
133NN1002X
Nutrition Education Nutritionist
—
—
225400000X
Rehabilitation Practitioner
—
—
225700000X
Massage Therapist
Primary
—
—
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1578777082
PSYCHOLOGY & WELLNESS
PR
Enumeration date
12/05/2018
Last updated
12/05/2018
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