1417829060 NPI number — PLAZA MENTAL HEALTH CLINIC 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 1417829060 NPI number — PLAZA MENTAL HEALTH CLINIC LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PLAZA MENTAL HEALTH CLINIC 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:
1417829060
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/23/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PMB 115 605 AVE TITO CASTRO NO 2431
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PONCE
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00716-0000
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-259-5555
Provider Business Mailing Address Fax Number:
787-295-8630

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
EDIFICIO PORRATA PILA 2431
Provider Second Line Business Practice Location Address:
BLVD LUIS A FERRE SUITE 208
Provider Business Practice Location Address City Name:
PONCE
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00717-2113
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-259-5555
Provider Business Practice Location Address Fax Number:
787-259-5555
Provider Enumeration Date:
09/23/2025

Additional Information

Authorized Official

Authorized Official Last Name:
PLAZA PAGAN
Authorized Official First Name:
YAIRLEIN
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT/OWNER
Authorized Official Telephone Number:
939-295-8630

Provider Taxonomy Codes

  • Taxonomy code: 103TC0700X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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