Healthcare Provider Details

I. General information

NPI: 1063302164
Provider Name (Legal Business Name): CUIDADO MENTAL COMPLETO, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/09/2025
Last Update Date: 07/09/2025
Certification Date: 07/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2431 BLVD LUIS A FERRE STE 207
PONCE PR
00717-2115
US

IV. Provider business mailing address

PO BOX 800378
COTO LAUREL PR
00780-0378
US

V. Phone/Fax

Practice location:
  • Phone: 787-974-0815
  • Fax:
Mailing address:
  • Phone: 787-974-0815
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0802X
TaxonomyAddiction Psychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: SANTOS MANUEL SANTIAGO PABON
Title or Position: PRESIDENT
Credential: MD
Phone: 787-974-0815