Provider Demographics
NPI:1265841852
Name:CENTRO DE DESARROLLO COGNITIVO
Entity Type:Organization
Organization Name:CENTRO DE DESARROLLO COGNITIVO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVIDSON
Authorized Official - Middle Name:
Authorized Official - Last Name:BAEZ RAMIREZ
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:787-233-2909
Mailing Address - Street 1:408 CALLE REINA
Mailing Address - Street 2:ESTANCIAS REALES
Mailing Address - City:SAN GERMAN
Mailing Address - State:PR
Mailing Address - Zip Code:00683-4168
Mailing Address - Country:US
Mailing Address - Phone:787-892-9911
Mailing Address - Fax:787-892-9911
Practice Address - Street 1:ALFONSO XII STREET ANEXO MUEBLERIA LA LUNA
Practice Address - Street 2:INTERAMERICAN UNIVERSITY AVENUE
Practice Address - City:SAN GERMAN
Practice Address - State:PR
Practice Address - Zip Code:00683
Practice Address - Country:US
Practice Address - Phone:787-892-9911
Practice Address - Fax:787-892-9911
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-07
Last Update Date:2014-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR4282254OtherLICENCE ID