Healthcare Provider Details

I. General information

NPI: 1588619985
Provider Name (Legal Business Name): INSTITUTO PSICOTERAPEUTICO DE PR
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/23/2006
Last Update Date: 12/06/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

431 AVE HOSTOS
SAN JUAN PR
00918-3014
US

IV. Provider business mailing address

PO BOX 9809
CAGUAS PR
00726-9809
US

V. Phone/Fax

Practice location:
  • Phone: 787-704-0705
  • Fax: 787-744-7444
Mailing address:
  • Phone: 787-704-0705
  • Fax: 787-744-7444

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code283Q00000X
TaxonomyPsychiatric Hospital
License NumberCASM0237
License Number StatePR

VIII. Authorized Official

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