Provider Demographics
NPI:1932453669
Name:CARLOS ALBIZU UNIVERSITY
Entity Type:Organization
Organization Name:CARLOS ALBIZU UNIVERSITY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYD PROGRAM DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:NANET
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:LOPEZ-CORDOVA
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:787-725-6500
Mailing Address - Street 1:PO BOX 9023711
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00902-3711
Mailing Address - Country:US
Mailing Address - Phone:787-725-6500
Mailing Address - Fax:787-721-7187
Practice Address - Street 1:CALLE TANCA 151 ESQUINA SAN FRANCISCO
Practice Address - Street 2:VIEJO SAN JUAN
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00902
Practice Address - Country:US
Practice Address - Phone:787-725-6500
Practice Address - Fax:787-721-7183
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-02
Last Update Date:2012-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1206103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty