Provider Demographics
NPI:1215207865
Name:ASSMCA
Entity Type:Organization
Organization Name:ASSMCA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SUPERVISOR
Authorized Official - Prefix:DR
Authorized Official - First Name:NOE
Authorized Official - Middle Name:
Authorized Official - Last Name:BARBOT
Authorized Official - Suffix:I
Authorized Official - Credentials:
Authorized Official - Phone:787-878-8038
Mailing Address - Street 1:7 TH STREET B-20 URB. CORALES
Mailing Address - Street 2:
Mailing Address - City:HATILLO
Mailing Address - State:PUERTO RICO
Mailing Address - Zip Code:00659
Mailing Address - Country:UM
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:639 AVE SAN LUIS
Practice Address - Street 2:
Practice Address - City:ARECIBO
Practice Address - State:PR
Practice Address - Zip Code:00612-3666
Practice Address - Country:US
Practice Address - Phone:787-878-8038
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-12
Last Update Date:2012-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR28641261QM0855X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health