Healthcare Provider Details

I. General information

NPI: 1255669974
Provider Name (Legal Business Name): PUERTO RICON CLINICAL AND FORENSIC PSYCHOLOGICAL SERVICES INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/19/2009
Last Update Date: 11/19/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CB6 CALLE EUCALIPTO RIOHONDO III,
BAYAMON PR
00961-3422
US

IV. Provider business mailing address

CB-6, CALLE EUCALIPTOS RIOHONDO III
BAYAMON PR
00961
US

V. Phone/Fax

Practice location:
  • Phone: 787-384-4013
  • Fax: 787-785-3985
Mailing address:
  • Phone: 787-384-4013
  • Fax: 787-785-3985

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: DR. FERNANDO MEDINA
Title or Position: PRESIDENT
Credential:
Phone: 787-384-4013