=====================================================
General NPI Number Information
=====================================================
NPI Number | 1497414171
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CARIBBEAN PSYCHOLOGY CENTER
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/10/2021
-----------------------------------------------------
Last Update Date | 12/10/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 8838 MONACILLOS 1771
-----------------------------------------------------
City | SAN JUAN
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00936-0093
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-919-9009
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 366306
-----------------------------------------------------
City | SAN JUAN
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00936-6306
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-919-9009
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | MR. JOSE A GARCIA
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 787-918-8097
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QM0801X
-----------------------------------------------------
Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------