Healthcare Provider Details

I. General information

NPI: 1356672968
Provider Name (Legal Business Name): CONSULTORES PSICOLOGICOS ASOCIADOS INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/21/2010
Last Update Date: 01/21/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8 CALLE RAMOS ANTONINI SUITE 205 (2DO PISO)
MAYAGUEZ PR
00680-4931
US

IV. Provider business mailing address

PO BOX 2188
SAN GERMAN PR
00683-2188
US

V. Phone/Fax

Practice location:
  • Phone: 787-538-4001
  • Fax: 787-265-6644
Mailing address:
  • Phone: 787-538-4001
  • Fax: 787-265-6644

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code302R00000X
TaxonomyHealth Maintenance Organization
License Number27667
License Number StatePR
# 2
Primary TaxonomyN
Taxonomy Code320800000X
TaxonomyMental Illness Community Based Residential Treatment Facility
License Number27667
License Number StatePR
# 3
Primary TaxonomyN
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number27667
License Number StatePR

VIII. Authorized Official

Name: MR. HERNAN PLAZAS
Title or Position: ORGANIZATION PRESIDENT
Credential: PSYCHOLOGIST
Phone: 787-538-4001