1306358965 NPI number — GRUPO DE SERVICIOS ESPECIALIZADOS EN PSICOLOGIA E INTERGATIVOS CORP

Table of content: (NPI 1306358965)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1306358965 NPI number — GRUPO DE SERVICIOS ESPECIALIZADOS EN PSICOLOGIA E INTERGATIVOS CORP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GRUPO DE SERVICIOS ESPECIALIZADOS EN PSICOLOGIA E INTERGATIVOS CORP
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:
1306358965
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/16/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 3563
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GUAYNABO
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00970-3563
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-404-5933
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
A11 CALLE GRANADA REPARTO ALHAMBRA LOCAL D
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BAYAMON
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00956
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-404-5933
Provider Business Practice Location Address Fax Number:
787-404-5933
Provider Enumeration Date:
11/03/2017

Additional Information

Authorized Official

Authorized Official Last Name:
RAMOS-RIVERA
Authorized Official First Name:
AMARILIS
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
787-404-5933

Provider Taxonomy Codes

  • Taxonomy code: 103T00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 103TP2701X , 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: HY132A , issued by the state of ( PR ) . This identifiers is of the category "MEDICAID".




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