1003045758 NPI number — SERVICIOS PSICOLOGICOS EDUCATIVOS

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1003045758 NPI number — SERVICIOS PSICOLOGICOS EDUCATIVOS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SERVICIOS PSICOLOGICOS EDUCATIVOS
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:
6
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:
1003045758
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/07/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
URB. PASEOS LOS ROBLES,
Provider Second Line Business Mailing Address:
EPIFANIO VIDAL # 1526
Provider Business Mailing Address City Name:
MAYAGUEZ
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00680
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-832-2117
Provider Business Mailing Address Fax Number:
787-891-2768

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
INTER 460 RAMAL 111
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
AGUADILLA
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00603
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-832-2117
Provider Business Practice Location Address Fax Number:
787-891-2768
Provider Enumeration Date:
07/02/2009

Additional Information

Authorized Official

Authorized Official Last Name:
SANTIAGO
Authorized Official First Name:
MARISOL
Authorized Official Middle Name:
Authorized Official Title or Position:
DIRECTOR
Authorized Official Telephone Number:
787-832-2117

Provider Taxonomy Codes

  • Taxonomy code: 103T00000X , with the licence number:  2506 , 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)





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