Healthcare Provider Details

I. General information

NPI: 1467725150
Provider Name (Legal Business Name): ALIANZA PSICOTERAPEUTICA DE PUERTO RICO, PSC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/12/2012
Last Update Date: 02/12/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 AVE FD ROOSEVELT SUITE 508
SAN JUAN PR
00918-2103
US

IV. Provider business mailing address

PO BOX 363161
SAN JUAN PR
00936-3161
US

V. Phone/Fax

Practice location:
  • Phone: 787-764-3737
  • Fax:
Mailing address:
  • Phone: 787-294-5871
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number17603
License Number StatePR
# 2
Primary TaxonomyY
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number17603
License Number StatePR

VIII. Authorized Official

Name: MARIO ROBERTO GONZALEZ-TORRES
Title or Position: PRESIDENT
Credential: M.D.
Phone: 787-294-5871