| Psicologia Avanzada Llc | |
|
Carr 908 Calle 26 Ba4 Bo. Tejas Humacao PR 00791-4056 | |
| (787) 852-9331 | |
| (787) 719-4681 |
| Full Name | Psicologia Avanzada Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | Carr 908, Humacao, Puerto Rico |
| Authorized Official Name and Position | Angel J Rivera Gomez (PRESIDENTE) |
| Authorized Official Contact | 7878529331 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Psicologia Avanzada Llc Aa2 Ave Tejas Correo Villa Pmb 132 Humacao PR 00791-4349 Ph: (787) 852-9331 | Psicologia Avanzada Llc Carr 908 Calle 26 Ba4 Bo. Tejas Humacao PR 00791-4056 Ph: (787) 852-9331 |
| NPI Number | 1912372889 |
|---|---|
| Provider Enumeration Date | 12/03/2015 |
| Last Update Date | 05/08/2017 |
| Medicare PECOS PAC ID | 1355620980 |
|---|---|
| Medicare Enrollment ID | O20161122000965 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1912372889 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | 3648 (Puerto Rico) | Primary |
| Provider Name | Angel J Rivera Gomez |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1447562178 PECOS PAC ID: 1456537455 Enrollment ID: I20110509000296 |
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