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General NPI Number Information
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NPI Number | 1740411024
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Entity Type | Organization
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Legal Business Name | CLINICA INTERDISCPLINARIA DE LA SALUD DE LA PUCPR
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Dates
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Enumeration Date | 08/04/2009
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Last Update Date | 08/04/2009
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Provider Practice Location Address
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Address Line | 2250 AVE LAS AMERICAS SUITE 631
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City | PONCE
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State | PR
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Zip | 00717-0655
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Country | US
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Telephone | 787-841-2000
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Fax |
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Provider Business Mailing Address
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Address Line | 2250 AVE LAS AMERICAS SUITE 631
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City | PONCE
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State | PR
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Zip | 00717-0655
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Country | US
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Telephone | 787-841-2000
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | ADA IRIS KERCADO
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Credential | M.ED.
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Telephone | 787-841-2000
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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 |
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License Number State |
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