Provider Demographics
NPI:1538302617
Name:INAYA PSYCHIATRIC MEDICAL GROUP, P.S.C.
Entity Type:Organization
Organization Name:INAYA PSYCHIATRIC MEDICAL GROUP, P.S.C.
Other - Org Name:INAYA'S PSYCHIATRIC MEDICAL GROUP, P.S.C.
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:ISHNAR
Authorized Official - Middle Name:M
Authorized Official - Last Name:LOPEZ RAMOS
Authorized Official - Suffix:
Authorized Official - Credentials:MBA
Authorized Official - Phone:787-850-4515
Mailing Address - Street 1:G11 VIA CUMBRES
Mailing Address - Street 2:URBANIZACION LA VISTA
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00924-4475
Mailing Address - Country:US
Mailing Address - Phone:787-850-4515
Mailing Address - Fax:787-852-6202
Practice Address - Street 1:CALLE FONT MARTELO 128 ESTE
Practice Address - Street 2:CLINICA DEL ESTE
Practice Address - City:HUMACAO
Practice Address - State:PR
Practice Address - Zip Code:00791
Practice Address - Country:US
Practice Address - Phone:787-850-4515
Practice Address - Fax:787-852-6202
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-20
Last Update Date:2009-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR6613261QM0850X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health