Healthcare Provider Details

I. General information

NPI: 1740115641
Provider Name (Legal Business Name): MIND BRIDGE CLINICAL SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/15/2026
Last Update Date: 06/15/2026
Certification Date: 06/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 CALLE ANGEL L ORTIZ
CAGUAS PR
00725-2656
US

IV. Provider business mailing address

60 URB LAKEVIEW EST
CAGUAS PR
00725-3383
US

V. Phone/Fax

Practice location:
  • Phone: 787-405-8634
  • Fax:
Mailing address:
  • Phone: 787-405-8634
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State

VIII. Authorized Official

Name: DR. JONATHAN FERNANDEZ
Title or Position: PRESIDENT
Credential: PSY.D.
Phone: 787-405-8634