MEDICARE: CENTRO SALUD MENTAL MAYAGUEZ

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)	5	PR

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	6800051	OTHER	PR	HUMANA
2	2445-2	OTHER	PR	AMPR
3	660405216-06	OTHER	PR	GOLDEN CROSS
4	SH-48116	OTHER	PR	UIA
5	222075	OTHER	PR	UTI
6	660433481-013	OTHER	PR	MCS
7	66173	OTHER	PR	CRUZ AZUL

General Provider Information

NPI Number	:	1265428601
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CENTRO SALUD MENTAL MAYAGUEZ

Provider Business Mailing Address
First Line	:	PO BOX 21485
Second Line	:
City	:	SAN JUAN
State	:	PR
Zip	:	00928-1485
Country	:	US
Telephone Number	:	787-766-4640
Fax Number	:	787-763-2344

Provider Business Practice Location Address
First Line	:	CARR 2
Second Line	:
City	:	MAYAGUEZ
State	:	PR
Zip	:	00682-6353
Country	:	US
Telephone Number	:	787-766-4640
Fax Number	:	787-763-2344

Authorized Official
Title or Position	:	DIRECTOR
Name	:	MR. CARLOS ELIAS LUGO
Credential	:
Telephone Number	:	787-766-4640

Provider Enumeration Date	:	09/21/2005
Last Update Date	:	08/22/2020

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Directions to “CENTRO SALUD MENTAL MAYAGUEZ ” Practice Location

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