Provider Demographics
NPI:1568933117
Name:PUERTO RICO MIND AND BODY HEALTH CSP
Entity Type:Organization
Organization Name:PUERTO RICO MIND AND BODY HEALTH CSP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:YUSSEL
Authorized Official - Middle Name:
Authorized Official - Last Name:GARCIA AMADOR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-647-0889
Mailing Address - Street 1:PO BOX 1553
Mailing Address - Street 2:
Mailing Address - City:HORMIGUEROS
Mailing Address - State:PR
Mailing Address - Zip Code:00660-5553
Mailing Address - Country:US
Mailing Address - Phone:787-470-9444
Mailing Address - Fax:
Practice Address - Street 1:187 AVE LOS ATLETICOS
Practice Address - Street 2:EDIF RALI 104
Practice Address - City:SAN GERMAN
Practice Address - State:PR
Practice Address - Zip Code:00683
Practice Address - Country:US
Practice Address - Phone:787-470-9444
Practice Address - Fax:787-659-7260
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-12-07
Last Update Date:2018-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty