Provider Demographics
NPI:1801015300
Name:CENTRO TRATAMIENTO AMBULATORIO PONCE
Entity Type:Organization
Organization Name:CENTRO TRATAMIENTO AMBULATORIO PONCE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:NORMA
Authorized Official - Middle Name:
Authorized Official - Last Name:VELASQUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-284-1230
Mailing Address - Street 1:PO BOX 21414
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00928-1414
Mailing Address - Country:US
Mailing Address - Phone:787-284-1230
Mailing Address - Fax:
Practice Address - Street 1:BO MACHUELOS CARR 14
Practice Address - Street 2:PABELLON C 2DO PISO ANEXO HOSP PSIQUIATRIA
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00732
Practice Address - Country:US
Practice Address - Phone:787-284-1230
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR261QR0405X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder