Healthcare Provider Details

I. General information

NPI: 1174742332
Provider Name (Legal Business Name): CENTRO TRATAMIENTO AMBULATORIO MAYAGUEZ
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/25/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

EDIF. CENTRO DEL OESTE CALLE RELAMPAGO 70
MAYAGUEZ PR
00680
US

IV. Provider business mailing address

PO BOX 21414
SAN JUAN PR
00928-1414
US

V. Phone/Fax

Practice location:
  • Phone: 787-833-5015
  • Fax:
Mailing address:
  • Phone: 787-833-5015
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number StatePR

VIII. Authorized Official

Name: MRS. BETZY RUIZ
Title or Position: DIRECTOR
Credential:
Phone: 787-833-5015