MEDICARE: CAGUAS PARCIAL

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	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)	97CNCNUM91173	PR

General Provider Information

NPI Number	:	1871740480
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CAGUAS PARCIAL

Provider Business Mailing Address
First Line	:	PO BOX 1400
Second Line	:
City	:	CIDRA
State	:	PR
Zip	:	00739-1400
Country	:	US
Telephone Number	:	787-739-5555
Fax Number	:	787-739-0035

Provider Business Practice Location Address
First Line	:	PLAZA CENTRO MALL
Second Line	:	SUITE # 7
City	:	CAGUAS
State	:	PR
Zip	:	00725-3740
Country	:	US
Telephone Number	:	787-286-2510
Fax Number	:	787-286-0494

Authorized Official
Title or Position	:	CEO
Name	:	MRS. TANIA E CONDE
Credential	:	MHSA
Telephone Number	:	787-739-5555

Provider Enumeration Date	:	08/26/2008
Last Update Date	:	08/26/2008

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Directions to “CAGUAS PARCIAL ” Practice Location

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