Healthcare Provider Details

I. General information

NPI: 1457381436
Provider Name (Legal Business Name): SAN GABRIEL COMM. MENTAL HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/04/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

NL14 VIA 22 VILLA FONTANA
CAROLINA PR
00983-3941
US

IV. Provider business mailing address

HC 02 PO BOX 14444
CAROLINA PR
00987
US

V. Phone/Fax

Practice location:
  • Phone: 787-762-8824
  • Fax:
Mailing address:
  • Phone: 787-762-8824
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code283X00000X
TaxonomyRehabilitation Hospital
License Number
License Number State

VIII. Authorized Official

Name: MRS. VICTORIA ROSADO RIOS
Title or Position: PRESIDENTA
Credential:
Phone: 787-762-8824