Healthcare Provider Details

I. General information

NPI: 1588983647
Provider Name (Legal Business Name): CLINICA DE SALUD MENTAL DE LA COMUNIDAD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/27/2010
Last Update Date: 03/20/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

151 CALLE TANCA OLD SAN JUAN
SAN JUAN PR
00901-1412
US

IV. Provider business mailing address

PO BOX 9023711
SAN JUAN PR
00902-3711
US

V. Phone/Fax

Practice location:
  • Phone: 787-725-6500
  • Fax: 787-977-4833
Mailing address:
  • Phone: 787-725-6500
  • Fax: 787-977-4833

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number32559
License Number StatePR

VIII. Authorized Official

Name: DR. ILEANA RODRIGUEZ-GARCIA
Title or Position: PRESIDENT
Credential: ED.D.
Phone: 787-725-6500