Healthcare Provider Details

I. General information

NPI: 1528486164
Provider Name (Legal Business Name): GRUPO SALUD MENTAL DEL SUR, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/01/2014
Last Update Date: 04/01/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

609 AVE TITO CASTRO SUITES 102 PMB 229
PONCE PR
00716-1692
US

IV. Provider business mailing address

1306 CALLE SALUD ESQ CAMPECHE
PONCE PR
00717-1692
US

V. Phone/Fax

Practice location:
  • Phone: 787-638-3090
  • Fax: 787-259-3331
Mailing address:
  • Phone: 787-638-3090
  • Fax: 787-259-3331

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. JOSE X. VAZQUEZ SR.
Title or Position: DIRECTOR
Credential:
Phone: 787-638-3090