Provider Demographics
NPI:1437266160
Name:GRUPO PSIQUIATRICO, CSP
Entity Type:Organization
Organization Name:GRUPO PSIQUIATRICO, CSP
Other - Org Name:GRUPO PSIQUIATRICO
Other - Org Type:Other Name
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:MARGARITA
Authorized Official - Last Name:FUMERO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-722-5006
Mailing Address - Street 1:PO BOX 19234
Mailing Address - Street 2:FERNANDEZ JUNCOS STATION
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00910-1234
Mailing Address - Country:US
Mailing Address - Phone:787-722-5006
Mailing Address - Fax:787-725-7490
Practice Address - Street 1:29 CALLE WASHINGTON
Practice Address - Street 2:SUITE 310
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00907-1510
Practice Address - Country:US
Practice Address - Phone:787-722-5006
Practice Address - Fax:787-725-7490
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR261QM0850X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR65810OtherCRUZ AZUL DE PR
PR26148OtherTRIPLE S, INC
PR65810OtherCRUZ AZUL DE PR