Healthcare Provider Details

I. General information

NPI: 1699976811
Provider Name (Legal Business Name): CENTRO PSICOLOGICO DEL ATENAS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/29/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

BULDING 78-1 CARR CIALES
MANATI PR
00674
US

IV. Provider business mailing address

BULDING 78-1 STREET TO CIALES
MANATI PR
00674
US

V. Phone/Fax

Practice location:
  • Phone: 787-884-5591
  • Fax:
Mailing address:
  • Phone: 787-884-5591
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number157
License Number StatePR

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier84142
Identifier TypeOTHER
Identifier StatePR
Identifier IssuerOPTIMO
# 2
Identifier01338
Identifier TypeOTHER
Identifier StatePR
Identifier IssuerAMERICAN HEALTH
# 3
Identifier84142
Identifier TypeOTHER
Identifier StatePR
Identifier IssuerSELECTO
# 4
Identifier9161
Identifier TypeOTHER
Identifier StatePR
Identifier IssuerINTERNATIONAL
# 5
Identifier84142
Identifier TypeOTHER
Identifier StatePR
Identifier IssuerAPS
# 6
Identifier219194
Identifier TypeOTHER
Identifier StatePR
Identifier IssuerPREFERED HEALTH
# 7
Identifier2198
Identifier TypeOTHER
Identifier StatePR
Identifier IssuerHUMANA
# 8
Identifier087421
Identifier TypeOTHER
Identifier StatePR
Identifier IssuerAMERICAN HEALTH MEDICARE
# 9
Identifier84142
Identifier TypeOTHER
Identifier StatePR
Identifier IssuerSSS

VIII. Authorized Official

Name: DR. PEDRO I GARCIA DELGADO
Title or Position: SICOLOGY
Credential:
Phone: 787-884-5591