Provider Demographics
NPI:1821523432
Name:SAN JORGE PEDIATRIC MENTAL HEALTH UNIT
Entity Type:Organization
Organization Name:SAN JORGE PEDIATRIC MENTAL HEALTH UNIT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP & EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSE
Authorized Official - Middle Name:L
Authorized Official - Last Name:RODRIGUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MHSA
Authorized Official - Phone:787-727-1000
Mailing Address - Street 1:253 CALLE SAN JORGE
Mailing Address - Street 2:SAN JORGE CORPORATE BUILDING 2B
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00912
Mailing Address - Country:US
Mailing Address - Phone:787-727-1000
Mailing Address - Fax:787-268-8702
Practice Address - Street 1:253 CALLE SAN JORGE
Practice Address - Street 2:SAN JORGE CORPORATE BUILDING 2B
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00912
Practice Address - Country:US
Practice Address - Phone:787-727-1000
Practice Address - Fax:787-268-8702
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SAN JORGE CHILDREN'S HOSPITAL, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-04-21
Last Update Date:2020-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health