Provider Demographics
NPI:1467674762
Name:AIDA DE PUERTO RICO
Entity Type:Organization
Organization Name:AIDA DE PUERTO RICO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:XAVIER
Authorized Official - Middle Name:
Authorized Official - Last Name:VAZQUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MED SAP
Authorized Official - Phone:787-259-3331
Mailing Address - Street 1:MARGINAL LA RAMBLA
Mailing Address - Street 2:AVE TITO CASTRO 629 SUITE 2002
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00716
Mailing Address - Country:US
Mailing Address - Phone:787-259-3331
Mailing Address - Fax:
Practice Address - Street 1:MARGINAL LA RAMBLA
Practice Address - Street 2:AVE TITO CASTRO 629 SUITE 2002
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00716
Practice Address - Country:US
Practice Address - Phone:787-259-3331
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PRCASM 0394261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)