Healthcare Provider Details

I. General information

NPI: 1043515869
Provider Name (Legal Business Name): ASSMCA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/26/2011
Last Update Date: 01/26/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

410 AVE HOSTOS SUITE7
MAYAGUEZ PR
00682-1560
US

IV. Provider business mailing address

410 AVE HOSTOS SUITE7
MAYAGUEZ PR
00682-1560
US

V. Phone/Fax

Practice location:
  • Phone: 787-833-0663
  • Fax:
Mailing address:
  • Phone: 787-833-0663
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number017935
License Number StatePR
# 2
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number017935
License Number StatePR
# 3
Primary TaxonomyN
Taxonomy Code261QC1500X
TaxonomyCommunity Health Clinic/Center
License Number017935
License Number StatePR
# 4
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number017935
License Number StatePR

VIII. Authorized Official

Name: GENARO MERCADO
Title or Position: NURSE
Credential: NURSE
Phone: 787-833-0663