Provider Demographics
NPI:1164816583
Name:MEDICAL PSYCHIATRIC SERVICES PSC
Entity Type:Organization
Organization Name:MEDICAL PSYCHIATRIC SERVICES PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JUAN
Authorized Official - Middle Name:JOSE
Authorized Official - Last Name:RODRIGUEZ VELEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-562-5414
Mailing Address - Street 1:1396 CALLE SAN RAFAEL
Mailing Address - Street 2:MEDICAL PAVILLION SUITE 4
Mailing Address - City:SAN JAUN
Mailing Address - State:PR
Mailing Address - Zip Code:00909
Mailing Address - Country:US
Mailing Address - Phone:787-725-2910
Mailing Address - Fax:
Practice Address - Street 1:1396 CALLE SAN RAFAEL
Practice Address - Street 2:MEDICAL PAVILLION SUITE 4
Practice Address - City:SAN JAUN
Practice Address - State:PR
Practice Address - Zip Code:00909
Practice Address - Country:US
Practice Address - Phone:787-725-2910
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-24
Last Update Date:2015-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR08550261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1285605980OtherDR. JUAN J RODRIGUEZ VELEZ NPI
PR08550OtherDR. JUAN J RODRIGUEZ VELEZ STATE LICENCES