Provider Demographics
NPI:1235124843
Name:CENTRO DE SALUD MENTAL DE SAN PATRICIO
Entity Type:Organization
Organization Name:CENTRO DE SALUD MENTAL DE SAN PATRICIO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:CARLOS
Authorized Official - Middle Name:ELIAS
Authorized Official - Last Name:LUGO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-766-4640
Mailing Address - Street 1:PO BOX 21485
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00928-1485
Mailing Address - Country:US
Mailing Address - Phone:787-766-4646
Mailing Address - Fax:787-763-2344
Practice Address - Street 1:AVE DE DIEGO CALLE CAADA
Practice Address - Street 2:PUERTO NUEVO
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00922
Practice Address - Country:US
Practice Address - Phone:787-766-4646
Practice Address - Fax:787-763-2344
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-20
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR12261QM0850X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR1019-5OtherAMPR
PR222032OtherPREFERRED HEALTH
PR82727OtherSSS
PR660433481-001OtherMCS
PR660405216-08OtherGOLDEN CROSS
PR69553OtherCRUZ AZUL
PR82727OtherSSS
PR81399Medicare ID - Type UnspecifiedPART B