Provider Demographics
NPI:1164630109
Name:ASSMCA
Entity Type:Organization
Organization Name:ASSMCA
Other - Org Name:PUERTO RICO HEALTH DEPARTMENT
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:SOCIAL WORKER
Authorized Official - Prefix:MR
Authorized Official - First Name:WILSON
Authorized Official - Middle Name:IVAN
Authorized Official - Last Name:GONZALEZ
Authorized Official - Suffix:
Authorized Official - Credentials:SW
Authorized Official - Phone:787-832-6771
Mailing Address - Street 1:424 CUMBRES DE MIRADERO
Mailing Address - Street 2:
Mailing Address - City:MAYAGUEZ
Mailing Address - State:PR
Mailing Address - Zip Code:00682-7518
Mailing Address - Country:US
Mailing Address - Phone:787-834-0598
Mailing Address - Fax:
Practice Address - Street 1:410 AVE HOSTOS STE 7
Practice Address - Street 2:ASSMCA, MEDIACL CENTER
Practice Address - City:MAYAGUEZ
Practice Address - State:PR
Practice Address - Zip Code:00682-1500
Practice Address - Country:US
Practice Address - Phone:787-832-6771
Practice Address - Fax:787-832-6771
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR4396261QM0850X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health