Provider Demographics
NPI:1376711028
Name:INSTITUTO PARA EL DESARROLLO PERSONAL, INC.
Entity Type:Organization
Organization Name:INSTITUTO PARA EL DESARROLLO PERSONAL, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENTA
Authorized Official - Prefix:DR
Authorized Official - First Name:GLORIA
Authorized Official - Middle Name:E
Authorized Official - Last Name:BAQUERO
Authorized Official - Suffix:
Authorized Official - Credentials:EDD
Authorized Official - Phone:787-703-4050
Mailing Address - Street 1:M31 CALLE 13
Mailing Address - Street 2:CONDADO MODERNO
Mailing Address - City:CAGUAS
Mailing Address - State:PR
Mailing Address - Zip Code:00725-2443
Mailing Address - Country:US
Mailing Address - Phone:787-703-4050
Mailing Address - Fax:787-703-4115
Practice Address - Street 1:364 CALLE SAN JORGE APT 4B
Practice Address - Street 2:CONDOMINIO LAS CARMELITAS
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00912-3318
Practice Address - Country:US
Practice Address - Phone:787-632-4049
Practice Address - Fax:787-722-3961
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-15
Last Update Date:2008-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)