Provider Demographics
NPI:1821209818
Name:ASSMCA
Entity Type:Organization
Organization Name:ASSMCA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ASIST. SERVICIOS PSICOSOCIALES
Authorized Official - Prefix:MR
Authorized Official - First Name:ANGEL
Authorized Official - Middle Name:D
Authorized Official - Last Name:SOTO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-833-0663
Mailing Address - Street 1:CALLE EUFRATES E 3 ESTANCIAS DE MONTE GRANDE
Mailing Address - Street 2:MONTE GRANDE
Mailing Address - City:CABO ROJO
Mailing Address - State:PR
Mailing Address - Zip Code:00623
Mailing Address - Country:US
Mailing Address - Phone:787-851-4884
Mailing Address - Fax:
Practice Address - Street 1:CALLE EUFRATES E 3 ESTANCIAS DE MONTE GRANDE
Practice Address - Street 2:MONTE GRANDE
Practice Address - City:CABO ROJO
Practice Address - State:PR
Practice Address - Zip Code:00623
Practice Address - Country:US
Practice Address - Phone:787-851-4884
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-24
Last Update Date:2008-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR261QC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health