Provider Demographics
NPI:1033494281
Name:PAX DE PUERTO RICO INC.
Entity Type:Organization
Organization Name:PAX DE PUERTO RICO INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ARIADNE
Authorized Official - Middle Name:RODRIGUEZ
Authorized Official - Last Name:VELAZQUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:PH D
Authorized Official - Phone:787-644-9925
Mailing Address - Street 1:49 JARDINES DEL CARIBE
Mailing Address - Street 2:#YY46
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00728-2654
Mailing Address - Country:US
Mailing Address - Phone:787-644-9925
Mailing Address - Fax:
Practice Address - Street 1:JARDINES DEL CARIBE 49
Practice Address - Street 2:YY46
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00731
Practice Address - Country:US
Practice Address - Phone:787-644-9925
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-19
Last Update Date:2011-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR4040251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health