=====================================================
General NPI Number Information
=====================================================
NPI Number | 1770073330
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CAPIF, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/18/2018
-----------------------------------------------------
Last Update Date | 02/17/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | CARR 417 KM 2.0 BO MALPASO
-----------------------------------------------------
City | AGUADA
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00602
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-672-0900
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 1308
-----------------------------------------------------
City | AGUADA
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00602-1308
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-672-0900
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | LUDITZA PEREZ
-----------------------------------------------------
Credential | MS
-----------------------------------------------------
Telephone | 787-672-0900
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103TF0000X
-----------------------------------------------------
Taxonomy Name | Family Psychologist
-----------------------------------------------------
License Number | 4311
-----------------------------------------------------
License Number State | PR
-----------------------------------------------------