Healthcare Provider Details

I. General information

NPI: 1992950141
Provider Name (Legal Business Name): CENTRO DE SERVICIOS PSICOEDUCATIVOS DEL OESTE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/01/2008
Last Update Date: 12/01/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CARRETAR 2 PLAZA LOS PEREGRINOS
HORMIGUEROS PR
00660
US

IV. Provider business mailing address

763 YAGUEZ ESTANCIAS DEL RIO
HORMIGUEROS PR
00660
US

V. Phone/Fax

Practice location:
  • Phone: 787-238-2948
  • Fax:
Mailing address:
  • Phone: 787-238-2948
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number1881
License Number StatePR
# 2
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number1881
License Number StatePR

VIII. Authorized Official

Name: DR. JOSUE MANUEL VEGA
Title or Position: PRESIDENT
Credential: PH.D
Phone: 787-536-0922