Healthcare Provider Details

I. General information

NPI: 1477943207
Provider Name (Legal Business Name): CORRECTIONAL HEALTH SERVICES CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/02/2015
Last Update Date: 02/02/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

235 CALLE MIGUEL RIVERA TEXIDOR ESTANCIAS DEL GOLF
PONCE PR
00730-0530
US

IV. Provider business mailing address

235 CALLE MIGUEL RIVERA TEXIDOR ESTANCIAS DEL GOLF
PONCE PR
00730
US

V. Phone/Fax

Practice location:
  • Phone: 787-632-3942
  • Fax: 787-841-6127
Mailing address:
  • Phone: 787-632-3942
  • Fax: 787-841-6127

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number2484
License Number StatePR
# 2
Primary TaxonomyY
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number2484
License Number StatePR

VIII. Authorized Official

Name: DR. REBECA CHRISTINA HERNANDEZ
Title or Position: PSICOLOGA CLINICA
Credential: PSY. D.
Phone: 787-632-3942