Healthcare Provider Details

I. General information

NPI: 1902256456
Provider Name (Legal Business Name): CENTRO DE SALUD MENTAL DEL OESTE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/15/2016
Last Update Date: 06/15/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

HC 4 BOX 13482
SAN GERMAN PR
00683-9568
US

IV. Provider business mailing address

HC 4 BOX 13482
SAN GERMAN PR
00683-9568
US

V. Phone/Fax

Practice location:
  • Phone: 787-517-9298
  • Fax:
Mailing address:
  • Phone: 787-517-9298
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number StatePR
# 2
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number StatePR
# 3
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number StatePR

VIII. Authorized Official

Name: DR. THAIZ RIVERA
Title or Position: PSYCHOLOGIST
Credential: PHD
Phone: 787-517-9298