Provider Demographics
NPI:1154864361
Name:INSTITUTO DE INTEGRACION Y PRESERVACION FAMILIAR PSC
Entity Type:Organization
Organization Name:INSTITUTO DE INTEGRACION Y PRESERVACION FAMILIAR PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENTE
Authorized Official - Prefix:
Authorized Official - First Name:LUIS
Authorized Official - Middle Name:
Authorized Official - Last Name:RIVERA SANTIAGO
Authorized Official - Suffix:SR
Authorized Official - Credentials:LCSW
Authorized Official - Phone:787-690-0598
Mailing Address - Street 1:1215 AVE FD ROOSEVELT
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00920
Mailing Address - Country:US
Mailing Address - Phone:787-690-0598
Mailing Address - Fax:
Practice Address - Street 1:1215 AVE FD ROOSEVELT
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00920
Practice Address - Country:US
Practice Address - Phone:787-690-0598
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-21
Last Update Date:2016-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR9458302F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302F00000XManaged Care OrganizationsExclusive Provider Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRCMS-10114Medicare UPIN
PRCMS-10114Medicare PIN