Healthcare Provider Details

I. General information

NPI: 1326478371
Provider Name (Legal Business Name): SERVICIOS INTEGRADOS DE SALUD MENTAL S.E.P.I.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/12/2013
Last Update Date: 11/12/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

EDIFICIO CARIBBEAN OFFICE PARK CARR 417 BO MALPASO
AGUADA PR
00602
US

IV. Provider business mailing address

90 CALLE COLON
AGUADA PR
00602
US

V. Phone/Fax

Practice location:
  • Phone: 787-868-1828
  • Fax: 787-868-1828
Mailing address:
  • Phone: 787-868-1828
  • Fax: 787-868-1828

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number20389
License Number StatePR
# 2
Primary TaxonomyY
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number20389
License Number StatePR

VIII. Authorized Official

Name: DR. ILIANETTE RUIZ
Title or Position: OWNER
Credential: MD
Phone: 787-868-1828