Provider Demographics
NPI:1639617681
Name:CLINICA INTERAMERICANA DE SERV. PSIC.
Entity Type:Organization
Organization Name:CLINICA INTERAMERICANA DE SERV. PSIC.
Other - Org Name:UNIVERSIDAD INTERAMERICANA DE PR
Other - Org Type:Other Name
Authorized Official - Title/Position:RECTORA
Authorized Official - Prefix:PROF
Authorized Official - First Name:MARILINA
Authorized Official - Middle Name:LUCCA
Authorized Official - Last Name:WAYLAND
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-250-1912
Mailing Address - Street 1:PO BOX 191293
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00919-1293
Mailing Address - Country:US
Mailing Address - Phone:787-250-1912
Mailing Address - Fax:
Practice Address - Street 1:CALLE FRANCISCO SEIN CARRETERA 1
Practice Address - Street 2:
Practice Address - City:RIO PIEDRAS
Practice Address - State:PR
Practice Address - Zip Code:00919
Practice Address - Country:US
Practice Address - Phone:787-250-1912
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-09
Last Update Date:2017-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)