Provider Demographics
NPI:1548411531
Name:PONCE MEDICAL SCHOOL FOUNDATION INC.
Entity Type:Organization
Organization Name:PONCE MEDICAL SCHOOL FOUNDATION INC.
Other - Org Name:SALUD CONDUCTUAL GRUPO PSICOLOGOS
Other - Org Type:Other Name
Authorized Official - Title/Position:ADMINISTRADOR
Authorized Official - Prefix:MR
Authorized Official - First Name:HECTOR
Authorized Official - Middle Name:
Authorized Official - Last Name:BURGOS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-614-2972
Mailing Address - Street 1:PO BOX 7004
Mailing Address - Street 2:
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00732-7004
Mailing Address - Country:US
Mailing Address - Phone:787-840-0052
Mailing Address - Fax:787-284-3619
Practice Address - Street 1:132 CALLE JOSE I QUINTON
Practice Address - Street 2:
Practice Address - City:COAMO
Practice Address - State:PR
Practice Address - Zip Code:00769-3041
Practice Address - Country:US
Practice Address - Phone:787-803-2110
Practice Address - Fax:787-803-2106
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-08
Last Update Date:2008-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty