Provider Demographics
NPI:1447230040
Name:MEDICAL PSYCHIATRIC GROUP,CSP
Entity Type:Organization
Organization Name:MEDICAL PSYCHIATRIC GROUP,CSP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHIATRIY-DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSE
Authorized Official - Middle Name:OMAR
Authorized Official - Last Name:GONZALEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-768-0390
Mailing Address - Street 1:ER139 PLAZA SERENA
Mailing Address - Street 2:
Mailing Address - City:TRUJILLO ALTO
Mailing Address - State:PR
Mailing Address - Zip Code:00976-6171
Mailing Address - Country:US
Mailing Address - Phone:787-276-2570
Mailing Address - Fax:787-768-1775
Practice Address - Street 1:MEDICAL PSYCHIATRIC CENTER
Practice Address - Street 2:MOLUCAS ST. 818 COUNTRY CLUB
Practice Address - City:RIO PIEDRAS
Practice Address - State:PR
Practice Address - Zip Code:00924
Practice Address - Country:US
Practice Address - Phone:787-768-0390
Practice Address - Fax:787-768-1775
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-19
Last Update Date:2023-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR10762261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty