Healthcare Provider Details

I. General information

NPI: 1538471115
Provider Name (Legal Business Name): SERVICIOS INTEGRADOS DE SALUD MENTAL INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/12/2010
Last Update Date: 10/07/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1404 AVE PAZ GRANELA SANTIAGO IGLESIAS
SAN JUAN PR
00921-4131
US

IV. Provider business mailing address

25 BLVD MEDIA LUNA COND. PARQUE DE LAS FLORES, APT. 704
CAROLINA PR
00987-4822
US

V. Phone/Fax

Practice location:
  • Phone: 787-373-7079
  • Fax: 787-707-8988
Mailing address:
  • Phone: 787-373-7079
  • Fax: 787-707-8988

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TA0700X
TaxonomyAdult Development & Aging Psychologist
License Number2141
License Number StatePR

VIII. Authorized Official

Name: DR. MARIA DEL AMOR RODRIGUEZ
Title or Position: PRESIDENT
Credential: DOCTOR PSYCOLOGY
Phone: 787-691-2973