Provider Demographics
NPI:1588796734
Name:CENTRO INTERDISCIPLINARIO PARA EL DESARROLLO DE LA NINEZ, INC.
Entity type:Organization
Organization Name:CENTRO INTERDISCIPLINARIO PARA EL DESARROLLO DE LA NINEZ, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:KETSIE
Authorized Official - Middle Name:IVELISSE
Authorized Official - Last Name:CALDERON-VIGO
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:787-344-7107
Mailing Address - Street 1:N22 CALLE CATARATAS
Mailing Address - Street 2:ALTURAS DE REMANSO
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00926-6119
Mailing Address - Country:US
Mailing Address - Phone:787-344-7107
Mailing Address - Fax:787-720-5091
Practice Address - Street 1:H13 VILLA DEL CARMEN
Practice Address - Street 2:AVENIDA LUIS MUNOZ MARIN
Practice Address - City:CAGUAS
Practice Address - State:PR
Practice Address - Zip Code:00725
Practice Address - Country:US
Practice Address - Phone:787-344-7107
Practice Address - Fax:787-720-5091
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service