Provider Demographics
NPI:1265428601
Name:CENTRO SALUD MENTAL MAYAGUEZ
Entity type:Organization
Organization Name:CENTRO SALUD MENTAL MAYAGUEZ
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:CARLOS
Authorized Official - Middle Name:ELIAS
Authorized Official - Last Name:LUGO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-766-4640
Mailing Address - Street 1:PO BOX 21485
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00928-1485
Mailing Address - Country:US
Mailing Address - Phone:787-766-4640
Mailing Address - Fax:787-763-2344
Practice Address - Street 1:CARR 2
Practice Address - Street 2:
Practice Address - City:MAYAGUEZ
Practice Address - State:PR
Practice Address - Zip Code:00682-6353
Practice Address - Country:US
Practice Address - Phone:787-766-4640
Practice Address - Fax:787-763-2344
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR5261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR6800051OtherHUMANA
PR2445-2OtherAMPR
PR660405216-06OtherGOLDEN CROSS
PRSH-48116OtherUIA
PR222075OtherUTI
PR660433481-013OtherMCS
PR66173OtherCRUZ AZUL
PRSH-48116OtherUIA
PR=========-00OtherCOSVI