Healthcare Provider Details

I. General information

NPI: 1356542138
Provider Name (Legal Business Name): ASSMCA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/30/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CENTRO DE SALUD MENTAL DE MAYAGUEZ 410 AVE OSTOS SUITE 7
MAYAGUEZ PR
00682-1522
US

IV. Provider business mailing address

PO BOX 1407
LAJAS PR
00667-1407
US

V. Phone/Fax

Practice location:
  • Phone: 787-899-6754
  • Fax:
Mailing address:
  • Phone: 787-899-6754
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MRS. MARTA S PEREZ
Title or Position: SUPERVISOR
Credential:
Phone: 787-832-6770