Provider Demographics
NPI:1104504919
Name:ASTACIO PSYCHOLOGICAL CLINIC
Entity type:Organization
Organization Name:ASTACIO PSYCHOLOGICAL CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ARACELYS
Authorized Official - Middle Name:
Authorized Official - Last Name:ASTACIO RUIZ
Authorized Official - Suffix:
Authorized Official - Credentials:DRA
Authorized Official - Phone:787-673-0685
Mailing Address - Street 1:URB VALLE REAL CALLE ISABEL 25002
Mailing Address - Street 2:
Mailing Address - City:ANASCO
Mailing Address - State:PR
Mailing Address - Zip Code:00610
Mailing Address - Country:US
Mailing Address - Phone:787-673-0685
Mailing Address - Fax:
Practice Address - Street 1:LOCAL 5 CARR 402 KM 2.9
Practice Address - Street 2:VALLEY HILLS PROFESSIONAL CENTER
Practice Address - City:ANASCO
Practice Address - State:PR
Practice Address - Zip Code:00610
Practice Address - Country:US
Practice Address - Phone:787-400-5484
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-07-11
Last Update Date:2023-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health