Provider Demographics
NPI:1194015321
Name:ASSMCA
Entity Type:Organization
Organization Name:ASSMCA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOCIAL WORK
Authorized Official - Prefix:MISS
Authorized Official - First Name:YAIDIMAR
Authorized Official - Middle Name:
Authorized Official - Last Name:RODRIGUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MSW
Authorized Official - Phone:939-325-9290
Mailing Address - Street 1:BARRION RINCON LOMA
Mailing Address - Street 2:PO BOX 1438
Mailing Address - City:CAYEY
Mailing Address - State:PR
Mailing Address - Zip Code:00737
Mailing Address - Country:US
Mailing Address - Phone:939-325-9290
Mailing Address - Fax:
Practice Address - Street 1:BLVD NICANOR VAZQUEZ TORRE 3 PISO 4
Practice Address - Street 2:
Practice Address - City:HUMACAO
Practice Address - State:PR
Practice Address - Zip Code:00792
Practice Address - Country:US
Practice Address - Phone:939-325-9290
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-08
Last Update Date:2011-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR9854251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR=========Medicare PIN