Healthcare Provider Details

I. General information

NPI: 1396290987
Provider Name (Legal Business Name): COALICION DE COALICIONES PRO PERSONAS SIN HOGAR DE PUERTO RICO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/24/2016
Last Update Date: 08/24/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

44 CALLE ISABEL
PONCE PR
00730-3722
US

IV. Provider business mailing address

44 CALLE ISABEL
PONCE PR
00730-3722
US

V. Phone/Fax

Practice location:
  • Phone: 787-812-0300
  • Fax: 787-812-0301
Mailing address:
  • Phone: 787-812-0300
  • Fax: 787-812-0301

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. FRANCISCO J RODRIGUEZ
Title or Position: PRESIDENTE EJECUTIVO
Credential:
Phone: 787-812-0300