MEDICARE: CLINICA SERVICIOS INTEGRALES PARA LA NINEZ Y ADOLESCENCIA DE SAN JUAN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QM0855X	Adolescent and Children Mental Health Clinic/Center		PR

General Provider Information

NPI Number	:	1043439383
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CLINICA SERVICIOS INTEGRALES PARA LA NINEZ Y ADOLESCENCIA DE SAN JUAN

Provider Business Mailing Address
First Line	:	900 CALLE CERRA
Second Line	:
City	:	SANTURCE
State	:	PR
Zip	:	00907-5104
Country	:	US
Telephone Number	:	787-721-3220
Fax Number	:	787-721-3207

Provider Business Practice Location Address
First Line	:	900 CALLE CERRA
Second Line	:
City	:	SANTURCE
State	:	PR
Zip	:	00907-5104
Country	:	US
Telephone Number	:	787-721-3220
Fax Number	:	787-721-3207

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	MRS. NITZA OTERO
Credential	:
Telephone Number	:	787-721-3220

Provider Enumeration Date	:	04/25/2007
Last Update Date	:	08/22/2020

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