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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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