Provider Demographics
NPI:1083736003
Name:MANGUAL PSYCHIATRIC SERVICES
Entity Type:Organization
Organization Name:MANGUAL PSYCHIATRIC SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:EFREN
Authorized Official - Middle Name:EDUARDO
Authorized Official - Last Name:MANGUAL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-524-4747
Mailing Address - Street 1:PO BOX 660
Mailing Address - Street 2:
Mailing Address - City:BOQUERON
Mailing Address - State:PR
Mailing Address - Zip Code:00622-0660
Mailing Address - Country:US
Mailing Address - Phone:787-254-4747
Mailing Address - Fax:787-254-4747
Practice Address - Street 1:34 CALLE MUNOZ RIVERA
Practice Address - Street 2:
Practice Address - City:CABO ROJO
Practice Address - State:PR
Practice Address - Zip Code:00623-3536
Practice Address - Country:US
Practice Address - Phone:787-254-4747
Practice Address - Fax:787-254-4747
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR126112084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty