Provider Demographics
NPI:1255669974
Name:PUERTO RICON CLINICAL AND FORENSIC PSYCHOLOGICAL SERVICES INC.
Entity type:Organization
Organization Name:PUERTO RICON CLINICAL AND FORENSIC PSYCHOLOGICAL SERVICES INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:FERNANDO
Authorized Official - Middle Name:
Authorized Official - Last Name:MEDINA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-384-4013
Mailing Address - Street 1:CB-6, CALLE EUCALIPTOS
Mailing Address - Street 2:RIOHONDO III
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00961
Mailing Address - Country:US
Mailing Address - Phone:787-384-4013
Mailing Address - Fax:787-785-3985
Practice Address - Street 1:CB6 CALLE EUCALIPTO
Practice Address - Street 2:RIOHONDO III,
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00961-3422
Practice Address - Country:US
Practice Address - Phone:787-384-4013
Practice Address - Fax:787-785-3985
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-19
Last Update Date:2009-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)