Provider Demographics
NPI:1801137427
Name:CENTRO PSIQUIATRICO CIBAO, INC
Entity type:Organization
Organization Name:CENTRO PSIQUIATRICO CIBAO, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ELIAS
Authorized Official - Middle Name:R
Authorized Official - Last Name:JIMENEZ OLIVO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-879-2425
Mailing Address - Street 1:PO BOX 1863
Mailing Address - Street 2:
Mailing Address - City:ARECIBO
Mailing Address - State:PR
Mailing Address - Zip Code:00613-1863
Mailing Address - Country:US
Mailing Address - Phone:787-879-2425
Mailing Address - Fax:787-879-2425
Practice Address - Street 1:#158 CALLE DR. SALAS
Practice Address - Street 2:
Practice Address - City:ARECIBO
Practice Address - State:PR
Practice Address - Zip Code:00612
Practice Address - Country:US
Practice Address - Phone:787-879-2425
Practice Address - Fax:787-879-2425
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CENTRO PSIQUIATRICO CIBAO, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-03-06
Last Update Date:2013-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)