Provider Demographics
NPI:1235528209
Name:EDNALIZ CAMACHO MONTES
Entity Type:Organization
Organization Name:EDNALIZ CAMACHO MONTES
Other - Org Name:CLINICA PIES DESCALZOS
Other - Org Type:Other Name
Authorized Official - Title/Position:PSYCOLOGICAL COUNSELOR
Authorized Official - Prefix:
Authorized Official - First Name:EDNALIZ
Authorized Official - Middle Name:
Authorized Official - Last Name:CAMACHO MONTES
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:787-597-7967
Mailing Address - Street 1:HC 1 BOX 2329
Mailing Address - Street 2:
Mailing Address - City:MAUNABO
Mailing Address - State:PR
Mailing Address - Zip Code:00707-7418
Mailing Address - Country:US
Mailing Address - Phone:785-977-9567
Mailing Address - Fax:
Practice Address - Street 1:3 AVE LOS VETERANOS B14
Practice Address - Street 2:VILLA ROSA
Practice Address - City:GUAYAMA
Practice Address - State:PR
Practice Address - Zip Code:00784
Practice Address - Country:US
Practice Address - Phone:787-484-4168
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-14
Last Update Date:2017-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR5646261QM0850X, 261QM0855X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health