Healthcare Provider Details

I. General information

NPI: 1700280500
Provider Name (Legal Business Name): INSTITUTO DE CAPACITACION Y DESARROLLO PROFESIONAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/22/2014
Last Update Date: 01/26/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1606 AVE PONCE DE LEON SUITE 1005
SAN JUAN PR
00909-1849
US

IV. Provider business mailing address

1606 AVE PONCE DE LEON SUITE 1005
SAN JUAN PR
00909-1849
US

V. Phone/Fax

Practice location:
  • Phone: 787-724-6604
  • Fax: 787-724-6604
Mailing address:
  • Phone: 787-724-6604
  • Fax: 787-724-6604

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TH0100X
TaxonomyHealth Service Psychologist
License Number
License Number State

VIII. Authorized Official

Name: MR. ANGEL M COLON
Title or Position: PRESIDENT
Credential:
Phone: 787-724-6604