Healthcare Provider Details

I. General information

NPI: 1235168394
Provider Name (Legal Business Name): INSTITUTO PSICOTERAPEUTICO DE PR
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/01/2006
Last Update Date: 06/24/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

TORRE AUXILIO MUTUO OFICINA 410
SAN JUAN PR
00917
US

IV. Provider business mailing address

PO BOX 367221
SAN JUAN PR
00936-7221
US

V. Phone/Fax

Practice location:
  • Phone: 787-296-0555
  • Fax: 787-296-0720
Mailing address:
  • Phone: 787-753-9515
  • Fax: 787-753-8327

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code283Q00000X
TaxonomyPsychiatric Hospital
License NumberCASM0276
License Number StatePR

VIII. Authorized Official

Name: DR. ALBERTO M VARELA
Title or Position: PRESIDENT
Credential: MD
Phone: 787-753-9515