1447230040 NPI number — MEDICAL PSYCHIATRIC GROUP,CSP

Table of content: (NPI 1447230040)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1447230040 NPI number — MEDICAL PSYCHIATRIC GROUP,CSP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MEDICAL PSYCHIATRIC GROUP,CSP
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:
1447230040
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/06/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
ER139 PLAZA SERENA
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TRUJILLO ALTO
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00976-6171
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-276-2570
Provider Business Mailing Address Fax Number:
787-768-1775

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
MEDICAL PSYCHIATRIC CENTER
Provider Second Line Business Practice Location Address:
MOLUCAS ST. 818 COUNTRY CLUB
Provider Business Practice Location Address City Name:
RIO PIEDRAS
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00924
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-768-0390
Provider Business Practice Location Address Fax Number:
787-768-1775
Provider Enumeration Date:
01/19/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
GONZALEZ
Authorized Official First Name:
JOSE
Authorized Official Middle Name:
OMAR
Authorized Official Title or Position:
PSYCHIATRIY-DIRECTOR
Authorized Official Telephone Number:
787-768-0390

Provider Taxonomy Codes

  • Taxonomy code: 261QM2500X , with the licence number:  10762 , 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)