Provider Demographics
NPI:1477867992
Name:ASSMCA
Entity type:Organization
Organization Name:ASSMCA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSING
Authorized Official - Prefix:MR
Authorized Official - First Name:REYNALDO
Authorized Official - Middle Name:
Authorized Official - Last Name:GONZALEZ
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:787-374-9208
Mailing Address - Street 1:VILLAS DE SAN AGUSTIN II CALLE 9 M37
Mailing Address - Street 2:
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00959
Mailing Address - Country:US
Mailing Address - Phone:787-374-9208
Mailing Address - Fax:787-995-5174
Practice Address - Street 1:M37 CALLE 9
Practice Address - Street 2:URB VILLAS DE SAN AGUSTIN II
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00959-2000
Practice Address - Country:US
Practice Address - Phone:787-374-9208
Practice Address - Fax:787-995-5174
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ASSMCA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-07-27
Last Update Date:2010-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR2340261QM0850X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health