Provider Demographics
NPI:1114049418
Name:R CORDOVA TRABAJADORES SOCIALES CSP
Entity Type:Organization
Organization Name:R CORDOVA TRABAJADORES SOCIALES CSP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MRS
Authorized Official - First Name:RITA
Authorized Official - Middle Name:
Authorized Official - Last Name:CORDOVA CAMPOS
Authorized Official - Suffix:
Authorized Official - Credentials:MSW ACSW
Authorized Official - Phone:787-593-0647
Mailing Address - Street 1:PMB 36 PO BOX 607071
Mailing Address - Street 2:
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00960-7071
Mailing Address - Country:US
Mailing Address - Phone:787-798-9097
Mailing Address - Fax:787-740-2559
Practice Address - Street 1:ROAD #2 BAYAMON SHOPPING CENTER
Practice Address - Street 2:SUITE #10E MINI MALL
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00959
Practice Address - Country:US
Practice Address - Phone:787-798-9097
Practice Address - Fax:787-740-2559
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR635OtherAPS HEALTH CARE