Provider Demographics
NPI:1902033327
Name:SERVICIOS MEDICOS PSIQUIATRICOS
Entity Type:Organization
Organization Name:SERVICIOS MEDICOS PSIQUIATRICOS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHIATRIST/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ALFONSO
Authorized Official - Middle Name:
Authorized Official - Last Name:MADRID
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-790-7269
Mailing Address - Street 1:PO BOX 195601
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00919-5601
Mailing Address - Country:US
Mailing Address - Phone:787-790-7269
Mailing Address - Fax:787-720-8133
Practice Address - Street 1:42 CALLE CARAZO
Practice Address - Street 2:
Practice Address - City:GUAYNABO
Practice Address - State:PR
Practice Address - Zip Code:00969-5635
Practice Address - Country:US
Practice Address - Phone:787-790-7269
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-11
Last Update Date:2009-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR7238261QM0850X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
0028547Medicare UPIN