Healthcare Provider Details

I. General information

NPI: 1033494281
Provider Name (Legal Business Name): PAX DE PUERTO RICO INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/19/2011
Last Update Date: 10/19/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

JARDINES DEL CARIBE 49 YY46
PONCE PR
00731
US

IV. Provider business mailing address

49 JARDINES DEL CARIBE #YY46
PONCE PR
00728-2654
US

V. Phone/Fax

Practice location:
  • Phone: 787-644-9925
  • Fax:
Mailing address:
  • Phone: 787-644-9925
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number4040
License Number StatePR

VIII. Authorized Official

Name: DR. ARIADNE RODRIGUEZ VELAZQUEZ
Title or Position: EXECUTIVE DIRECTOR
Credential: PH. D
Phone: 787-644-9925