Provider Demographics
NPI:1841530557
Name:CENTRO PSIQUIATRICO DE BAYAMON CORP
Entity type:Organization
Organization Name:CENTRO PSIQUIATRICO DE BAYAMON CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:OSCAR
Authorized Official - Middle Name:ANTONIO
Authorized Official - Last Name:CARDONA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-798-4550
Mailing Address - Street 1:43-15 AVE MAIN
Mailing Address - Street 2:URB. SANTA ROSA
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00959-6501
Mailing Address - Country:US
Mailing Address - Phone:787-798-4335
Mailing Address - Fax:
Practice Address - Street 1:43-15 AVE MAIN
Practice Address - Street 2:URB. SANTA ROSA
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00959-6501
Practice Address - Country:US
Practice Address - Phone:787-798-4335
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-18
Last Update Date:2013-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR5382261QM0855X, 261QM0850X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR028244OtherTRIPLE S
PR1194721258OtherMEDICAL CARD SYSTEM
PR096060OtherHUMANA HEALTH CARE
PR028244OtherTRIPLE S
PR1194721258OtherMEDICAL CARD SYSTEM