Provider Demographics
NPI:1518093566
Name:CENTRO RESIDENSIAL DE MUJERES DE SAN JUAN
Entity Type:Organization
Organization Name:CENTRO RESIDENSIAL DE MUJERES DE SAN JUAN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINIC DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:DELIA
Authorized Official - Middle Name:PATRICIA
Authorized Official - Last Name:GONZALEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-765-2050
Mailing Address - Street 1:PO BOX 21414
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00928-1414
Mailing Address - Country:US
Mailing Address - Phone:787-765-2050
Mailing Address - Fax:
Practice Address - Street 1:CALLE MAGA PABELLON B
Practice Address - Street 2:BO MONACILLOS
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00926
Practice Address - Country:US
Practice Address - Phone:787-765-2050
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR323P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes323P00000XResidential Treatment FacilitiesPsychiatric Residential Treatment Facility