Provider Demographics
NPI:1073831707
Name:VANESSA BERRIOS PH D & ASSOCIADOS PSC
Entity Type:Organization
Organization Name:VANESSA BERRIOS PH D & ASSOCIADOS PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:VANESSA
Authorized Official - Middle Name:
Authorized Official - Last Name:BERRIOS MENDEZ
Authorized Official - Suffix:
Authorized Official - Credentials:PH D
Authorized Official - Phone:787-290-1111
Mailing Address - Street 1:PO BOX 800104
Mailing Address - Street 2:
Mailing Address - City:COTO LAUREL
Mailing Address - State:PR
Mailing Address - Zip Code:00780-0104
Mailing Address - Country:US
Mailing Address - Phone:787-290-1111
Mailing Address - Fax:787-290-1111
Practice Address - Street 1:2275 PONCE BY PASS
Practice Address - Street 2:
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00717-1380
Practice Address - Country:US
Practice Address - Phone:787-290-1111
Practice Address - Fax:787-290-1111
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-05
Last Update Date:2010-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR001177261QM0850X, 261QM0855X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health