Healthcare Provider Details

I. General information

NPI: 1669224200
Provider Name (Legal Business Name): SERVICIOS CLINICOS INTERDISCIPLINARIOS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/05/2024
Last Update Date: 04/05/2024
Certification Date: 04/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3020 AVE SAN CRISTOBAL
COTO LAUREL PR
00780-2896
US

IV. Provider business mailing address

1013 CALLE LOS FLAMBOYANES
COTO LAUREL PR
00780-2240
US

V. Phone/Fax

Practice location:
  • Phone: 939-835-7173
  • Fax:
Mailing address:
  • Phone: 939-835-7173
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State
# 7
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name: GIOVANNI ALOMAR SASTRE
Title or Position: PRESIDENT / OWNER
Credential: PH D
Phone: 939-835-7173