1376674671 NPI number — GP MENTAL HEALTH ASSOCIATES

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 1376674671 NPI number — GP MENTAL HEALTH ASSOCIATES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GP MENTAL HEALTH ASSOCIATES
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:
1376674671
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:
1353 AVE LUIS VIGOREAUX
Provider Second Line Business Mailing Address:
PMB 466
Provider Business Mailing Address City Name:
GUAYNABO
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00966-2715
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-688-7924
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
TORRE PROFESIONAL OFICINA 302
Provider Second Line Business Practice Location Address:
HOSPITAL MENONITA
Provider Business Practice Location Address City Name:
CAYEY
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00736
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-552-7979
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/08/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
PASTRANA
Authorized Official First Name:
VIVIAN
Authorized Official Middle Name:
RAQUEL
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
787-735-6102

Provider Taxonomy Codes

  • Taxonomy code: 261QM0850X , with the licence number:  15304 , 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)