MEDICARE: MINDS PRIME INC.

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	2084P0800X	Psychiatry Physician

General Provider Information

NPI Number	:	1568001121
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MINDS PRIME INC.

Provider Business Mailing Address
First Line	:	URB CONDADO VIEJO H17
Second Line	:	CALLE JOSE VILLARES
City	:	CAGUAS
State	:	PR
Zip	:	00725-2463
Country	:	US
Telephone Number	:	787-510-6187
Fax Number	:

Provider Business Practice Location Address
First Line	:	URB CONDADO VIEJO H17
Second Line	:	CALLE JOSE VILLARES
City	:	CAGUAS
State	:	PR
Zip	:	00725-2463
Country	:	US
Telephone Number	:	787-510-6187
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	ANGEL MARTINEZ
Credential	:
Telephone Number	:	787-510-6187

Provider Enumeration Date	:	12/31/2019
Last Update Date	:	02/06/2026

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