Provider Demographics
NPI:1851578769
Name:INSTITUTO DE DESARROLLO INTEGRAL Y EVALUACION
Entity Type:Organization
Organization Name:INSTITUTO DE DESARROLLO INTEGRAL Y EVALUACION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MARY
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:MARTINEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-364-9880
Mailing Address - Street 1:PO BOX 5442
Mailing Address - Street 2:
Mailing Address - City:CAGUAS
Mailing Address - State:PR
Mailing Address - Zip Code:00726-5442
Mailing Address - Country:US
Mailing Address - Phone:787-364-9880
Mailing Address - Fax:
Practice Address - Street 1:AVE CHUMLEY Q11
Practice Address - Street 2:TURABO GARDENS
Practice Address - City:CAGUAS
Practice Address - State:PR
Practice Address - Zip Code:00727
Practice Address - Country:US
Practice Address - Phone:787-364-9880
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-23
Last Update Date:2013-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR987261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)