Provider Demographics
NPI:1750889812
Name:UNIVERSIDAD CENTRAL DEL CARIBE, INC.
Entity type:Organization
Organization Name:UNIVERSIDAD CENTRAL DEL CARIBE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHILD AND ADOLESCENT PSYCHIATRY
Authorized Official - Prefix:DR
Authorized Official - First Name:INGRID
Authorized Official - Middle Name:
Authorized Official - Last Name:CASAS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-269-0988
Mailing Address - Street 1:PO BOX 60327
Mailing Address - Street 2:
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00960-6032
Mailing Address - Country:US
Mailing Address - Phone:787-269-0988
Mailing Address - Fax:787-966-7923
Practice Address - Street 1:300 AVE LAUREL
Practice Address - Street 2:ESQUINA BELLISIMA
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00956-3268
Practice Address - Country:US
Practice Address - Phone:787-269-0988
Practice Address - Fax:787-966-7923
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-24
Last Update Date:2018-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR148732084P0804X, 2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty
No2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent PsychiatryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR1255495412Medicaid