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General NPI Number Information
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NPI Number | 1407102486
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Entity Type | Organization
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Legal Business Name | CENTRO INTEGRADO DE SERVICIOS PSICOLOGICOS, CP
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Dates
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Enumeration Date | 07/27/2012
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Last Update Date | 07/27/2012
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Provider Practice Location Address
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Address Line | 60 CALLE DAGUEY
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City | ANASCO
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State | PR
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Zip | 00610-2603
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Country | US
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Telephone | 787-229-1222
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 500
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City | ANASCO
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State | PR
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Zip | 00610-9806
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Country | US
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Telephone | 787-229-1222
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Fax |
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Authorized Official
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Title or Position | ADMINISTRADOR
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Name | MR. JONATHAN MUNIZ
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Credential | M.S.
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Telephone | 787-229-1222
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number |
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License Number State | PR
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