Provider Demographics
NPI:1851362735
Name:INNOVATIVE PSYCHIATRIC GROUP, PSC
Entity Type:Organization
Organization Name:INNOVATIVE PSYCHIATRIC GROUP, PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FACTURADORA
Authorized Official - Prefix:MRS
Authorized Official - First Name:FRANCES
Authorized Official - Middle Name:Y
Authorized Official - Last Name:MARCANO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-380-1377
Mailing Address - Street 1:J14 CALLE 16
Mailing Address - Street 2:URB CIUDAD UNIVERSITARIA
Mailing Address - City:TRUJILLO ALTO
Mailing Address - State:PR
Mailing Address - Zip Code:00976-3124
Mailing Address - Country:US
Mailing Address - Phone:787-539-2681
Mailing Address - Fax:787-961-3920
Practice Address - Street 1:BF4 CALLE LA PINTA
Practice Address - Street 2:URB BAIROA
Practice Address - City:CAGUAS
Practice Address - State:PR
Practice Address - Zip Code:00725
Practice Address - Country:US
Practice Address - Phone:787-539-2681
Practice Address - Fax:787-961-3920
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-30
Last Update Date:2016-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty