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General NPI Number Information
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NPI Number | 1164640421
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Entity Type | Organization
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Legal Business Name | ASSMCA
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Dates
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Enumeration Date | 04/23/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | ASSMCA SAN PATRICIO, EDIF 4 ANTIGUO HOSPITAL DE VETERANOS AVE. DE DIEGO
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City | SAN JUAN
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State | PR
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Zip | 00928-1414
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Country | US
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Telephone | 787-706-1866
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Fax | 787-782-2282
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Provider Business Mailing Address
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Address Line | PO BOX 21414
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City | SAN JUAN
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State | PR
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Zip | 00928-1414
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Country | US
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Telephone | 787-706-1866
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Fax | 787-782-2282
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Authorized Official
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Title or Position | DIRECTOR CENTRO
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Name | ORLANDO TORRES
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Credential | P.H.D.
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Telephone | 787-706-1866
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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 | 07-F-1998
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License Number State | PR
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