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General NPI Number Information
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NPI Number | 1093001729
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Entity Type | Organization
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Legal Business Name | PSICOLOGOS CLINICOS DEL SANTURCE MEDICAL MALL, CSP
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Dates
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Enumeration Date | 06/21/2011
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Last Update Date | 06/21/2011
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Provider Practice Location Address
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Address Line | 1801 AVE PONCE DE LEON SUITE 311
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City | SAN JUAN
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State | PR
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Zip | 00909-1900
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Country | US
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Telephone | 787-727-2424
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Fax | 787-727-2424
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Provider Business Mailing Address
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Address Line | 1801 AVE PONCE DE LEON SUITE 311
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City | SAN JUAN
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State | PR
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Zip | 00909-1900
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Country | US
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Telephone | 787-727-2424
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Fax | 787-727-2424
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. MARIA ELIZABETH CHAVEZ
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Credential | PH.D.
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Telephone | 787-727-2424
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number | 1165
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License Number State | PR
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