Healthcare Provider Details

I. General information

NPI: 1598750192
Provider Name (Legal Business Name): ADMINISTRACION DE SERVICIOS DE SALUD MENTAL Y CONTRA LA ADICCION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/20/2005
Last Update Date: 12/05/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

COND MAGA BO MONACILLOS CENTRO MEDICO
SAN JUAN PR
00907-1966
US

IV. Provider business mailing address

PO BOX 2100
SAN JUAN PR
00922-2100
US

V. Phone/Fax

Practice location:
  • Phone: 787-766-4646
  • Fax: 787-763-2344
Mailing address:
  • Phone: 787-766-4646
  • Fax: 787-763-2344

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code283Q00000X
TaxonomyPsychiatric Hospital
License Number9
License Number StatePR

VIII. Authorized Official

Name: JIMMY BAEZ SALGADO
Title or Position: MANAGER
Credential:
Phone: 787-763-7575