Provider Demographics
NPI:1164640421
Name:ASSMCA
Entity Type:Organization
Organization Name:ASSMCA
Other - Org Name:CSM DE SAN PATRICIO
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR CENTRO
Authorized Official - Prefix:
Authorized Official - First Name:ORLANDO
Authorized Official - Middle Name:
Authorized Official - Last Name:TORRES
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:787-706-1866
Mailing Address - Street 1:PO BOX 21414
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00928-1414
Mailing Address - Country:US
Mailing Address - Phone:787-706-1866
Mailing Address - Fax:787-782-2282
Practice Address - Street 1:ASSMCA SAN PATRICIO, EDIF 4
Practice Address - Street 2:ANTIGUO HOSPITAL DE VETERANOS AVE. DE DIEGO
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00928-1414
Practice Address - Country:US
Practice Address - Phone:787-706-1866
Practice Address - Fax:787-782-2282
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR07-F-1998261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)