Provider Demographics
NPI:1043819097
Name:VIVE PSICOLOGIA INTEGRAL LLC
Entity type:Organization
Organization Name:VIVE PSICOLOGIA INTEGRAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:DEL PILAR
Authorized Official - Last Name:ROSA
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:787-423-3002
Mailing Address - Street 1:URB PASEO DE LOS ARTESANOS
Mailing Address - Street 2:151 CALLE ALEJANDRO LOZADA
Mailing Address - City:LAS PIEDRAS
Mailing Address - State:PR
Mailing Address - Zip Code:00771
Mailing Address - Country:US
Mailing Address - Phone:787-423-3002
Mailing Address - Fax:
Practice Address - Street 1:CARRETERA 198 KM 21.7
Practice Address - Street 2:BO. ARENAS
Practice Address - City:LAS PIEDRAS
Practice Address - State:PR
Practice Address - Zip Code:00771
Practice Address - Country:US
Practice Address - Phone:787-423-3002
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-21
Last Update Date:2020-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PREV778AMedicaid