Healthcare Provider Details

I. General information

NPI: 1902200033
Provider Name (Legal Business Name): PRYMED SALUD MENTAL CIALES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/17/2014
Last Update Date: 10/17/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

ROAD 149 KM 12.3
CIALES PR
00638
US

IV. Provider business mailing address

PO BOX 1427
CIALES PR
00638-1427
US

V. Phone/Fax

Practice location:
  • Phone: 787-871-0601
  • Fax: 787-871-3960
Mailing address:
  • Phone: 787-871-0601
  • Fax: 787-871-3960

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number36
License Number StatePR
# 2
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number36
License Number StatePR

VIII. Authorized Official

Name: MRS. MARISOL VEGA
Title or Position: FINANCE DIRECTOR
Credential:
Phone: 787-871-0601