Healthcare Provider Details

I. General information

NPI: 1437266160
Provider Name (Legal Business Name): GRUPO PSIQUIATRICO, CSP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/25/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

29 CALLE WASHINGTON SUITE 310
SAN JUAN PR
00907-1510
US

IV. Provider business mailing address

PO BOX 19234 FERNANDEZ JUNCOS STATION
SAN JUAN PR
00910-1234
US

V. Phone/Fax

Practice location:
  • Phone: 787-722-5006
  • Fax: 787-725-7490
Mailing address:
  • Phone: 787-722-5006
  • Fax: 787-725-7490

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number StatePR

VIII. Authorized Official

Name: MARIA MARGARITA FUMERO
Title or Position: ADMINISTRATOR
Credential:
Phone: 787-722-5006