Healthcare Provider Details

I. General information

NPI: 1801015300
Provider Name (Legal Business Name): CENTRO TRATAMIENTO AMBULATORIO PONCE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/24/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

BO MACHUELOS CARR 14 PABELLON C 2DO PISO ANEXO HOSP PSIQUIATRIA
PONCE PR
00732
US

IV. Provider business mailing address

PO BOX 21414
SAN JUAN PR
00928-1414
US

V. Phone/Fax

Practice location:
  • Phone: 787-284-1230
  • Fax:
Mailing address:
  • Phone: 787-284-1230
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number StatePR

VIII. Authorized Official

Name: MRS. NORMA VELASQUEZ
Title or Position: DIRECTOR
Credential:
Phone: 787-284-1230