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General NPI Number Information
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NPI Number | 1235124843
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Entity Type | Organization
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Legal Business Name | CENTRO DE SALUD MENTAL DE SAN PATRICIO
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Dates
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Enumeration Date | 09/20/2005
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | AVE DE DIEGO CALLE CAADA PUERTO NUEVO
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City | SAN JUAN
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State | PR
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Zip | 00922
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Country | US
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Telephone | 787-766-4646
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Fax | 787-763-2344
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Provider Business Mailing Address
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Address Line | PO BOX 21485
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City | SAN JUAN
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State | PR
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Zip | 00928-1485
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Country | US
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Telephone | 787-766-4646
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Fax | 787-763-2344
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Authorized Official
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Title or Position | DIRECTOR
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Name | MR. CARLOS ELIAS LUGO
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Credential |
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Telephone | 787-766-4640
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number | 12
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License Number State | PR
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