Provider Demographics
NPI:1326370958
Name:INSTITUTO DE SERVICIOS EDUCATIVOS DE PUERTO RICO
Entity Type:Organization
Organization Name:INSTITUTO DE SERVICIOS EDUCATIVOS DE PUERTO RICO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ALICIA
Authorized Official - Middle Name:
Authorized Official - Last Name:FERNANDEZ
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:787-647-9305
Mailing Address - Street 1:AVE SANCHEZ OSORIO
Mailing Address - Street 2:5 H 4 VILLA FONTANA PARK
Mailing Address - City:CAROLINA
Mailing Address - State:PR
Mailing Address - Zip Code:00983-3226
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:AVE SANCHEZ OSORIO
Practice Address - Street 2:5 H 4 VILLA FONTANA PARK
Practice Address - City:CAROLINA
Practice Address - State:PR
Practice Address - Zip Code:00983-3226
Practice Address - Country:US
Practice Address - Phone:787-768-3320
Practice Address - Fax:787-276-8616
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-07
Last Update Date:2010-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TR0400XBehavioral Health & Social Service ProvidersPsychologistRehabilitationGroup - Multi-Specialty