1538302617 NPI number — INAYA PSYCHIATRIC MEDICAL GROUP, P.S.C.

Table of content: (NPI 1538302617)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1538302617 NPI number — INAYA PSYCHIATRIC MEDICAL GROUP, P.S.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
INAYA PSYCHIATRIC MEDICAL GROUP, P.S.C.
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:
INAYA'S PSYCHIATRIC MEDICAL GROUP, P.S.C.
Provider Other Organization Name Type Code:
5
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:
1538302617
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/20/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
G11 VIA CUMBRES
Provider Second Line Business Mailing Address:
URBANIZACION LA VISTA
Provider Business Mailing Address City Name:
SAN JUAN
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00924-4475
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-850-4515
Provider Business Mailing Address Fax Number:
787-852-6202

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
CALLE FONT MARTELO 128 ESTE
Provider Second Line Business Practice Location Address:
CLINICA DEL ESTE
Provider Business Practice Location Address City Name:
HUMACAO
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00791
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-850-4515
Provider Business Practice Location Address Fax Number:
787-852-6202
Provider Enumeration Date:
04/20/2009

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
LOPEZ RAMOS
Authorized Official First Name:
ISHNAR
Authorized Official Middle Name:
M
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
787-850-4515

Provider Taxonomy Codes

  • Taxonomy code: 261QM0850X , with the licence number:  6613 , 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)