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Boulevard Del Rio Office Building A-3 Ramal 3, Bo Ctano Humacao PR 00791-0073 | |
| (787) 434-1700 | |
| (787) 434-1711 |
| Full Name | |
|---|---|
| Speciality | Clinic/center - Mental Health (including Community Mental Health Center) |
| Location | Boulevard Del Rio Office Building A-3, Humacao, Puerto Rico |
| Authorized Official Name and Position | Lissette Vasquez Rivera (DIRECTOR) |
| Authorized Official Contact | 7874341700 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
Po Box 1650 Cidra PR 00739-1650 Ph: (787) 434-1700 | Boulevard Del Rio Office Building A-3 Ramal 3, Bo Ctano Humacao PR 00791-0073 Ph: (787) 434-1700 |
| NPI Number | 1487371399 |
|---|---|
| Provider Enumeration Date | 10/21/2022 |
| Last Update Date | 01/21/2025 |
| Certification Date | 01/21/2025 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1487371399 | NPI | - | NPPES |
| 6 | Other | PR | LICENCIA OPERACIONAL |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | (* (Not Available)) | Primary |
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