Provider Demographics
NPI:1336468180
Name:CENTRO DE EVALUACION, TRATAMIENTOS Y SALUD INTEGRADA
Entity Type:Organization
Organization Name:CENTRO DE EVALUACION, TRATAMIENTOS Y SALUD INTEGRADA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSICOLOGA
Authorized Official - Prefix:DR
Authorized Official - First Name:MARIE
Authorized Official - Middle Name:D
Authorized Official - Last Name:ORTIZ EMMANUELLI
Authorized Official - Suffix:
Authorized Official - Credentials:DOCTORADO
Authorized Official - Phone:787-944-4411
Mailing Address - Street 1:CALLE SABANA EXT VALLE ALTO
Mailing Address - Street 2:# 2241
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00730-4143
Mailing Address - Country:US
Mailing Address - Phone:787-944-4411
Mailing Address - Fax:
Practice Address - Street 1:CALLE SABANA EXT VALLE ALTO
Practice Address - Street 2:# 2241
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00730-4143
Practice Address - Country:US
Practice Address - Phone:787-944-4411
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-19
Last Update Date:2010-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR2578103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR1538149547OtherNPI