Provider Demographics
NPI:1679828032
Name:SERVICIOS MULTIDICIPLINARIOS PARA LA CONDUCTA HUMANA
Entity Type:Organization
Organization Name:SERVICIOS MULTIDICIPLINARIOS PARA LA CONDUCTA HUMANA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSICOLOGA
Authorized Official - Prefix:DR
Authorized Official - First Name:JANNETTE
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:MORALES RIVERA
Authorized Official - Suffix:
Authorized Official - Credentials:PH D
Authorized Official - Phone:787-448-7401
Mailing Address - Street 1:HC-02 BOX 9429
Mailing Address - Street 2:
Mailing Address - City:JUANA DIAZ
Mailing Address - State:PR
Mailing Address - Zip Code:00795-9614
Mailing Address - Country:US
Mailing Address - Phone:787-448-7401
Mailing Address - Fax:787-844-4569
Practice Address - Street 1:BRISAS DEL CARIBE CALLE 6 CASA 198
Practice Address - Street 2:
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00728
Practice Address - Country:US
Practice Address - Phone:787-448-7401
Practice Address - Fax:787-844-4569
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-20
Last Update Date:2012-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR4299261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR=========Medicare Oscar/Certification