Healthcare Provider Details

I. General information

NPI: 1790858660
Provider Name (Legal Business Name): CENTRO DE SALUD CONDUCTUAL DE PONCE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/16/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CALLE MONTERREY 279 ZONA INDUSTRIAL REPARA 2
PONCE PR
00732
US

IV. Provider business mailing address

PO BOX 7004
PONCE PR
00732-7004
US

V. Phone/Fax

Practice location:
  • Phone: 787-840-2575
  • Fax: 787-840-8391
Mailing address:
  • Phone: 787-840-2575
  • Fax: 787-840-8391

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: MR. HECTOR BURGOS
Title or Position: GERENTE DE OPERACIONES
Credential:
Phone: 787-840-2575