Provider Demographics
NPI:1295048734
Name:ASSMCA
Entity type:Organization
Organization Name:ASSMCA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REGIONAL DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:CARMEN
Authorized Official - Middle Name:GLORIA
Authorized Official - Last Name:CRUZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-831-3714
Mailing Address - Street 1:410 AVE HOSTOS
Mailing Address - Street 2:SUITE 7 CENTRO SALUD MENTAL MAYAGUEZ
Mailing Address - City:MAYAGUEZ
Mailing Address - State:PR
Mailing Address - Zip Code:00682-1522
Mailing Address - Country:US
Mailing Address - Phone:787-831-3714
Mailing Address - Fax:787-831-3714
Practice Address - Street 1:410 AVE HOSTOS
Practice Address - Street 2:SUITE 7 CENTRO SALUD MENTAL MAYAGUEZ
Practice Address - City:MAYAGUEZ
Practice Address - State:PR
Practice Address - Zip Code:00682-1522
Practice Address - Country:US
Practice Address - Phone:787-831-3714
Practice Address - Fax:787-831-3714
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-26
Last Update Date:2010-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR017935261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)