Provider Demographics
NPI:1811212574
Name:ON TIME THERAPEUTIC CLINIC
Entity Type:Organization
Organization Name:ON TIME THERAPEUTIC CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:MIGUEL
Authorized Official - Middle Name:
Authorized Official - Last Name:COLON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-279-3787
Mailing Address - Street 1:CALLE 50 A FINAL BLOQUE 7 #8
Mailing Address - Street 2:URB. ROYAL TOWN
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00956
Mailing Address - Country:US
Mailing Address - Phone:787-279-3787
Mailing Address - Fax:787-799-4800
Practice Address - Street 1:CALLE 50 A FINAL BLOQUE 7 #8
Practice Address - Street 2:ROYAL TOWN
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00956
Practice Address - Country:US
Practice Address - Phone:787-279-3787
Practice Address - Fax:787-799-4800
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-06
Last Update Date:2010-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1751103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty