Provider Demographics
NPI:1154532505
Name:SERVICIOS PSIQUIATRICOS DR. RICARDO DIEZ DELGADO, CSP
Entity type:Organization
Organization Name:SERVICIOS PSIQUIATRICOS DR. RICARDO DIEZ DELGADO, CSP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RICARDO
Authorized Official - Middle Name:
Authorized Official - Last Name:DIEZ-DELGADO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-763-1816
Mailing Address - Street 1:PO BOX 363603
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00936-3603
Mailing Address - Country:US
Mailing Address - Phone:787-763-1816
Mailing Address - Fax:787-282-8424
Practice Address - Street 1:124 WINSTON CHURCHILL ESQ. PARANA,
Practice Address - Street 2:PISO 2, OFIC. 5
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00936-3603
Practice Address - Country:US
Practice Address - Phone:787-763-1816
Practice Address - Fax:787-282-8424
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR9226261QM0850X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR067698OtherCRUZ AZUL
PR85182OtherTRIPLE S
PR096193OtherAUXILIO PLATINO
PR2826OtherMMM
PR2824OtherAPS HUMANA
PR6327OtherINTERNATIONAL MEDICAL
PR2824OtherAPS HUMANA
PR2826OtherMMM
PR=========OtherPREFERRED MEDICAL
PR096193OtherAUXILIO PLATINO
PR=========OtherMCS