Healthcare Provider Details

I. General information

NPI: 1376674671
Provider Name (Legal Business Name): GP MENTAL HEALTH ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/08/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

TORRE PROFESIONAL OFICINA 302 HOSPITAL MENONITA
CAYEY PR
00736
US

IV. Provider business mailing address

1353 AVE LUIS VIGOREAUX PMB 466
GUAYNABO PR
00966-2715
US

V. Phone/Fax

Practice location:
  • Phone: 787-552-7979
  • Fax:
Mailing address:
  • Phone: 787-688-7924
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number15304
License Number StatePR

VIII. Authorized Official

Name: DR. VIVIAN RAQUEL PASTRANA
Title or Position: PRESIDENT
Credential: M.D.
Phone: 787-735-6102