Provider Demographics
NPI:1568867018
Name:DRA BETSY RUIZ PLACIDO CSP
Entity Type:Organization
Organization Name:DRA BETSY RUIZ PLACIDO CSP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BETSY
Authorized Official - Middle Name:
Authorized Official - Last Name:RUIZ PLACIDO
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:787-385-9167
Mailing Address - Street 1:PO BOX 770
Mailing Address - Street 2:
Mailing Address - City:HORMIGUEROS
Mailing Address - State:PR
Mailing Address - Zip Code:00660-0770
Mailing Address - Country:US
Mailing Address - Phone:787-810-3144
Mailing Address - Fax:
Practice Address - Street 1:COND MEDICAL CENTER PLZ STE 213
Practice Address - Street 2:740 AVE. HOSTOS
Practice Address - City:MAYAGUEZ
Practice Address - State:PR
Practice Address - Zip Code:00682-1539
Practice Address - Country:US
Practice Address - Phone:787-810-3144
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-27
Last Update Date:2016-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR3303261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR1861632242Medicare PIN