Provider Demographics
NPI:1508115163
Name:CENTRO DE SERVICIOS PSICOLOGICOS PUENTES
Entity Type:Organization
Organization Name:CENTRO DE SERVICIOS PSICOLOGICOS PUENTES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:DAISY
Authorized Official - Middle Name:
Authorized Official - Last Name:PELLOT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-819-1111
Mailing Address - Street 1:PO BOX 4512
Mailing Address - Street 2:
Mailing Address - City:AGUADILLA
Mailing Address - State:PR
Mailing Address - Zip Code:00605-4512
Mailing Address - Country:US
Mailing Address - Phone:787-819-1111
Mailing Address - Fax:
Practice Address - Street 1:CARR. 111 KM. 0.7
Practice Address - Street 2:BO. PALMAR
Practice Address - City:AGUADILLA
Practice Address - State:PR
Practice Address - Zip Code:00603
Practice Address - Country:US
Practice Address - Phone:787-819-1111
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-29
Last Update Date:2012-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1925261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)