Provider Demographics
NPI:1366116626
Name:RISEUP WELLNESS PR LLC
Entity type:Organization
Organization Name:RISEUP WELLNESS PR LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL PSYCHOLOGIST/ FOUNDER
Authorized Official - Prefix:DR
Authorized Official - First Name:FRANCES
Authorized Official - Middle Name:ENID
Authorized Official - Last Name:OSTOLAZA SANTIAGO
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:787-512-2058
Mailing Address - Street 1:614 VILLA NAVARRA CALLE GARCIA LEDESMA
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00924
Mailing Address - Country:US
Mailing Address - Phone:787-512-2058
Mailing Address - Fax:
Practice Address - Street 1:101 AVE SAN PATRICIO STE 1240
Practice Address - Street 2:
Practice Address - City:GUAYNABO
Practice Address - State:PR
Practice Address - Zip Code:00968-3057
Practice Address - Country:US
Practice Address - Phone:787-512-2058
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-02
Last Update Date:2021-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TH0100XBehavioral Health & Social Service ProvidersPsychologistHealth ServiceGroup - Single Specialty