Provider Demographics
NPI:1700280500
Name:INSTITUTO DE CAPACITACION Y DESARROLLO PROFESIONAL
Entity Type:Organization
Organization Name:INSTITUTO DE CAPACITACION Y DESARROLLO PROFESIONAL
Other - Org Name:INSTITUTO DE DESARROLLO PROFESIONAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ANGEL
Authorized Official - Middle Name:M
Authorized Official - Last Name:COLON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-724-6604
Mailing Address - Street 1:1606 AVE PONCE DE LEON
Mailing Address - Street 2:SUITE 1005
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00909-1849
Mailing Address - Country:US
Mailing Address - Phone:787-724-6604
Mailing Address - Fax:787-724-6604
Practice Address - Street 1:1606 AVE PONCE DE LEON
Practice Address - Street 2:SUITE 1005
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00909-1849
Practice Address - Country:US
Practice Address - Phone:787-724-6604
Practice Address - Fax:787-724-6604
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-22
Last Update Date:2015-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty
Yes103TH0100XBehavioral Health & Social Service ProvidersPsychologistHealth ServiceGroup - Multi-Specialty
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & AdolescentGroup - Multi-Specialty
No103TF0000XBehavioral Health & Social Service ProvidersPsychologistFamilyGroup - Multi-Specialty