1154532505 NPI number — SERVICIOS PSIQUIATRICOS DR. RICARDO DIEZ DELGADO, CSP

Table of content: (NPI 1154532505)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1154532505 NPI number — SERVICIOS PSIQUIATRICOS DR. RICARDO DIEZ DELGADO, CSP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SERVICIOS PSIQUIATRICOS DR. RICARDO DIEZ DELGADO, CSP
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1154532505
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 363603
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAN JUAN
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00936-3603
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-763-1816
Provider Business Mailing Address Fax Number:
787-282-8424

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
124 WINSTON CHURCHILL ESQ. PARANA,
Provider Second Line Business Practice Location Address:
PISO 2, OFIC. 5
Provider Business Practice Location Address City Name:
SAN JUAN
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00936-3603
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-763-1816
Provider Business Practice Location Address Fax Number:
787-282-8424
Provider Enumeration Date:
05/25/2007

Additional Information

Authorized Official

Authorized Official Last Name:
DIEZ-DELGADO
Authorized Official First Name:
RICARDO
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
787-763-1816

Provider Taxonomy Codes

  • Taxonomy code: 261QM0850X , with the licence number:  9226 , registered in the state of PR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 067698 . This is a "CRUZ AZUL" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 85182 . This is a "TRIPLE S" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 096193 . This is a "AUXILIO PLATINO" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 2826 . This is a "MMM" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 2824 . This is a "APS HUMANA" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 6327 . This is a "INTERNATIONAL MEDICAL" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".




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