1205565660 NPI number — CLINICA DE SERVICIOS PSICOLOGICOS DESPERTAR LLC

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 1205565660 NPI number — CLINICA DE SERVICIOS PSICOLOGICOS DESPERTAR LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CLINICA DE SERVICIOS PSICOLOGICOS DESPERTAR LLC
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:
1205565660
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/09/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
20 AVE LUIS MUNOZ MARIN PMB 349
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CAGUAS
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00725-1956
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-639-8894
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
TORRE MEDICA SAN PABLO PISO 5
Provider Second Line Business Practice Location Address:
SUITE 504
Provider Business Practice Location Address City Name:
FAJARDO
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00738-3998
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-639-8894
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/09/2022

Additional Information

Authorized Official

Authorized Official Last Name:
QUINONES SANCHEZ
Authorized Official First Name:
KAREN
Authorized Official Middle Name:
Z
Authorized Official Title or Position:
PSYCHOLOGIST
Authorized Official Telephone Number:
787-528-8175

Provider Taxonomy Codes

  • Taxonomy code: 103TH0004X ; 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