1013573435 NPI number — CENTRO PSICOTERAPEUTICO CORP

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 1013573435 NPI number — CENTRO PSICOTERAPEUTICO CORP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CENTRO PSICOTERAPEUTICO 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:
1013573435
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/10/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 141717
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ARECIBO
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00614
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-879-5550
Provider Business Mailing Address Fax Number:
787-879-5550

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
AVENIDA VICTOR ROJAS
Provider Second Line Business Practice Location Address:
ESQUINA JUAN COLON PADILLA 19
Provider Business Practice Location Address City Name:
ARECIBO
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00612
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-879-5550
Provider Business Practice Location Address Fax Number:
787-879-5550
Provider Enumeration Date:
05/10/2019

Additional Information

Authorized Official

Authorized Official Last Name:
ROBLES
Authorized Official First Name:
JORGE
Authorized Official Middle Name:
R
Authorized Official Title or Position:
PSYCHIATRIST
Authorized Official Telephone Number:
787-879-5550

Provider Taxonomy Codes

  • Taxonomy code: 2084P0800X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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