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General NPI Number Information
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NPI Number | 1437433927
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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 | 10/04/2011
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Last Update Date | 10/04/2011
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Provider Practice Location Address
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Address Line | H20 CALLE A
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City | CAROLINA
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State | PR
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Zip | 00985-5565
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Country | US
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Telephone | 787-463-9094
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Fax |
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Provider Business Mailing Address
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Address Line | H20 CALLE A
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City | CAROLINA
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State | PR
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Zip | 00985-5565
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Country | US
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Telephone | 787-463-9094
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Fax |
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Authorized Official
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Title or Position | NURSE
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Name | MR. JOSE A CHEVERE
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Credential | L.P.N
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Telephone | 787-463-9094
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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 | 34657
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License Number State | PR
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