Provider Demographics
NPI:1932405255
Name:CENTRO HOLISTICO BIENESTAR MENTAL
Entity Type:Organization
Organization Name:CENTRO HOLISTICO BIENESTAR MENTAL
Other - Org Name:CENTRO HOLISTICO PARA EL BIENESTAR DE LA SALUD MENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:ANISSA
Authorized Official - Middle Name:V
Authorized Official - Last Name:HERNANDEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-326-2259
Mailing Address - Street 1:PO BOX 547
Mailing Address - Street 2:
Mailing Address - City:GURABO
Mailing Address - State:PR
Mailing Address - Zip Code:00778-0547
Mailing Address - Country:US
Mailing Address - Phone:787-656-3198
Mailing Address - Fax:787-656-3198
Practice Address - Street 1:C9 AVE LUIS MUNOZ MARIN
Practice Address - Street 2:
Practice Address - City:CAGUAS
Practice Address - State:PR
Practice Address - Zip Code:00725-3330
Practice Address - Country:US
Practice Address - Phone:787-326-2259
Practice Address - Fax:939-204-9060
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-03
Last Update Date:2019-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR146972084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty