Provider Demographics
NPI:1851625248
Name:SANTA CRUZ BEHAVIORAL PSC
Entity Type:Organization
Organization Name:SANTA CRUZ BEHAVIORAL PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:
Authorized Official - Last Name:JULIO DE JESUS
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:787-798-4592
Mailing Address - Street 1:PO BOX 8129
Mailing Address - Street 2:
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00960
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:73 SANTA CRUZ STREET
Practice Address - Street 2:SUITE 212
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00961
Practice Address - Country:US
Practice Address - Phone:787-798-4592
Practice Address - Fax:787-798-8236
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-01
Last Update Date:2013-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR147452084P0805X
PR30322084P0805X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0805XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyGeriatric PsychiatryGroup - Multi-Specialty