Healthcare Provider Details

I. General information

NPI: 1295177269
Provider Name (Legal Business Name): EUREKA MENTAL HEALTH & WELLNES CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/19/2013
Last Update Date: 07/19/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PR-4494 KM 2.6 PLAZA CAMUY BUILDING
CAMUY PR
00627
US

IV. Provider business mailing address

PO BOX 30500 PMB 247
MANATI PR
00674
US

V. Phone/Fax

Practice location:
  • Phone: 787-427-4722
  • Fax: 787-854-0650
Mailing address:
  • Phone: 787-427-4722
  • Fax: 787-854-0650

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number005177
License Number StatePR
# 2
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number005177
License Number StatePR

VIII. Authorized Official

Name: DR. SONIA MARIA MEDINA
Title or Position: DHIEF EXECUTIVE OFFICER
Credential: PH.D.
Phone: 787-427-4722