Provider Demographics
NPI:1861651010
Name:OFICINA PSIQUIATRICA HISPANA
Entity Type:Organization
Organization Name:OFICINA PSIQUIATRICA HISPANA
Other - Org Name:CLINICA PSIQUIATRICA HISPANA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:XAVIER
Authorized Official - Middle Name:
Authorized Official - Last Name:SAN MIGUEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-899-9300
Mailing Address - Street 1:3768 91ST ST
Mailing Address - Street 2:
Mailing Address - City:JACKSON HEIGHTS
Mailing Address - State:NY
Mailing Address - Zip Code:11372-7928
Mailing Address - Country:US
Mailing Address - Phone:718-899-9300
Mailing Address - Fax:718-899-9199
Practice Address - Street 1:3768 91ST ST
Practice Address - Street 2:
Practice Address - City:JACKSON HEIGHTS
Practice Address - State:NY
Practice Address - Zip Code:11372-7928
Practice Address - Country:US
Practice Address - Phone:718-899-9300
Practice Address - Fax:718-899-9199
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-03
Last Update Date:2008-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1939402084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty