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NPI Code Detail

MEDICARE: THE BEHAVIORAL GROUP, PSC

MEDICARE: THE BEHAVIORAL GROUP, PSC
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
1207PE0004XEmergency Medical Services (Emergency Medicine) Physician13958PR

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
113958OTHERPRLICENSE

General Provider Information

NPI Number : 1730539644
Entity Type Code : Organization
Provider Name (Legal Business Name) : THE BEHAVIORAL GROUP, PSC
Provider Business Mailing Address
First Line : 130 AVE WINSTON CHURCHILL
Second Line : PMB 359 SUITE 1
City : SAN JUAN
State : PR
Zip : 00926-6065
Country : US
Telephone Number : 787-545-2718
Fax Number : 787-545-2794
Provider Business Practice Location Address
First Line : COND MAGA
Second Line : BO MONACILLOS CENTRO MEDICO
City : SAN JUAN
State : PR
Zip : 00907-1966
Country : US
Telephone Number : 787-545-2718
Fax Number : 787-545-2794
Authorized Official
Title or Position : PRESIDENT
Name : DR. JORGE MEJIA VALLE
Credential : M.D.
Telephone Number : 787-545-2718
Provider Enumeration Date : 06/21/2016
Last Update Date : 06/21/2016

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Directions to “THE BEHAVIORAL GROUP, PSC ” Practice Location

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