Provider Demographics
NPI:1083630156
Name:HECTOR J GUERRA
Entity Type:Organization
Organization Name:HECTOR J GUERRA
Other - Org Name:CLINICAL SUPPORT GROUP INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:ALICE
Authorized Official - Middle Name:
Authorized Official - Last Name:RUSCALLEDA
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:787-768-5501
Mailing Address - Street 1:1432 CALLE BARRACUDA
Mailing Address - Street 2:BAHIA VISTAMAR
Mailing Address - City:CAROLINA
Mailing Address - State:PR
Mailing Address - Zip Code:00983-1451
Mailing Address - Country:US
Mailing Address - Phone:787-768-5501
Mailing Address - Fax:787-768-8094
Practice Address - Street 1:1432 CALLE BARRACUDA
Practice Address - Street 2:BAHIA VISTAMAR
Practice Address - City:CAROLINA
Practice Address - State:PR
Practice Address - Zip Code:00983-1451
Practice Address - Country:US
Practice Address - Phone:787-768-5501
Practice Address - Fax:787-768-8094
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-14
Last Update Date:2009-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103TC0700X, 225X00000X
PR91401041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR0087677Medicare PIN