Healthcare Provider Details

I. General information

NPI: 1336745280
Provider Name (Legal Business Name): CENTRO DE SERVICIOS DE SALUD Y BIENESTAR HUMANO CORP.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/07/2020
Last Update Date: 02/01/2021
Certification Date: 02/01/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

AVENUE JOSE GAUTIER BENITEZ #86 Y #88
CAGUAS PR
00725-0072
US

IV. Provider business mailing address

HC 4 BOX 47199
CAGUAS PR
00725
US

V. Phone/Fax

Practice location:
  • Phone: 787-448-3302
  • Fax:
Mailing address:
  • Phone: 787-448-3302
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: MRS. WILMA M CASTELLANOS
Title or Position: OWNER
Credential:
Phone: 787-448-3302