Organization
MANTIS WELLNESS CENTER LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. FERNANDO RODRIGUEZ NIEVES BA (ADMINISTRADOR)
(787) 360-9657
Entity
Organization
Contact information
Practice address
URB FLAMINGO TERRACE A7 MARG 167, BAYAMON, PR 00957
(787) 981-3037
Mailing address
URB FLAMINGO TERRACE A7 MARG 167, BAYAMON, PR 00957
(787) 981-3037
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
—
—
103TC0700X
Clinical Psychologist
Primary
—
—
103TC1900X
Counseling Psychologist
—
—
103TS0200X
School Psychologist
—
—
1041C0700X
Clinical Social Worker
—
—
Other
Enumeration date
03/18/2021
Last updated
03/18/2021
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