Healthcare Provider Details

I. General information

NPI: 1750889812
Provider Name (Legal Business Name): UNIVERSIDAD CENTRAL DEL CARIBE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/24/2018
Last Update Date: 01/24/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 AVE LAUREL ESQUINA BELLISIMA
BAYAMON PR
00956-3268
US

IV. Provider business mailing address

PO BOX 60327
BAYAMON PR
00960-6032
US

V. Phone/Fax

Practice location:
  • Phone: 787-269-0988
  • Fax: 787-966-7923
Mailing address:
  • Phone: 787-269-0988
  • Fax: 787-966-7923

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number14873
License Number StatePR
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number14873
License Number StatePR

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier1255495412
Identifier TypeMEDICAID
Identifier StatePR
Identifier Issuer

VIII. Authorized Official

Name: DR. INGRID CASAS
Title or Position: CHILD AND ADOLESCENT PSYCHIATRY
Credential: MD
Phone: 787-269-0988