1235124843 NPI number — CENTRO DE SALUD MENTAL DE SAN PATRICIO

Table of content: (NPI 1235124843)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1235124843 NPI number — CENTRO DE SALUD MENTAL DE SAN PATRICIO

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CENTRO DE SALUD MENTAL DE SAN PATRICIO
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:
1235124843
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/21/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 21485
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:
00928-1485
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-766-4646
Provider Business Mailing Address Fax Number:
787-763-2344

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
AVE DE DIEGO CALLE CAADA
Provider Second Line Business Practice Location Address:
PUERTO NUEVO
Provider Business Practice Location Address City Name:
SAN JUAN
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00922
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-766-4646
Provider Business Practice Location Address Fax Number:
787-763-2344
Provider Enumeration Date:
09/20/2005

Additional Information

Authorized Official

Authorized Official Last Name:
LUGO
Authorized Official First Name:
CARLOS
Authorized Official Middle Name:
ELIAS
Authorized Official Title or Position:
DIRECTOR
Authorized Official Telephone Number:
787-766-4640

Provider Taxonomy Codes

  • Taxonomy code: 261QM0850X , with the licence number:  12 , 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: 1019-5 . This is a "AMPR" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 222032 . This is a "PREFERRED HEALTH" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 82727 . This is a "SSS" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 660433481-001 . This is a "MCS" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 660405216-08 . This is a "GOLDEN CROSS" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 69553 . This is a "CRUZ AZUL" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".




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