1467663005 NPI number — PSYCHOTHERAPEUTIC HEALTH SYSTEM, PSC

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 1467663005 NPI number — PSYCHOTHERAPEUTIC HEALTH SYSTEM, PSC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PSYCHOTHERAPEUTIC HEALTH SYSTEM, PSC
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:
1467663005
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/10/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 4960
Provider Second Line Business Mailing Address:
PMB 413
Provider Business Mailing Address City Name:
CAGUAS
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00726-4960
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-738-7455
Provider Business Mailing Address Fax Number:
787-535-7505

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
101 SUR CALLE CORCHADO
Provider Second Line Business Practice Location Address:
ESQUINA NUNEZ ROMEU
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:
787-738-7455
Provider Business Practice Location Address Fax Number:
787-535-7505
Provider Enumeration Date:
05/25/2007

Additional Information

Authorized Official

Authorized Official Last Name:
FLORES
Authorized Official First Name:
DAVID
Authorized Official Middle Name:
A
Authorized Official Title or Position:
PROPIETARIO
Authorized Official Telephone Number:
787-738-7455

Provider Taxonomy Codes

  • Taxonomy code: 261QM0801X , with the licence number:  12370 , 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)





Copyright © 2007-2025 www.npivalidator.com