Provider Demographics
NPI:1376314567
Name:PSYMED CLINIC, PSC
Entity Type:Organization
Organization Name:PSYMED CLINIC, PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:FRANCISCO
Authorized Official - Middle Name:
Authorized Official - Last Name:RODRIGUEZ BARRERA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:939-525-0525
Mailing Address - Street 1:4952 CALLE SANTA PAULA
Mailing Address - Street 2:URB SANTA TERESITA
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00730
Mailing Address - Country:US
Mailing Address - Phone:939-525-0525
Mailing Address - Fax:
Practice Address - Street 1:4952 CALLE SANTA PAULA
Practice Address - Street 2:URB SANTA TERESITA
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00730
Practice Address - Country:US
Practice Address - Phone:939-525-0525
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-16
Last Update Date:2024-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
No133N00000XDietary & Nutritional Service ProvidersNutritionistGroup - Multi-Specialty
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty