Provider Demographics
NPI:1215354907
Name:GRUPO ESPECIALIZADO EN MEDICINA SIQUIATRICA,INC. (GEMAS ,LLC)
Entity type:Organization
Organization Name:GRUPO ESPECIALIZADO EN MEDICINA SIQUIATRICA,INC. (GEMAS ,LLC)
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHEL
Authorized Official - Middle Name:A
Authorized Official - Last Name:WOODBURY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-226-1899
Mailing Address - Street 1:307 CALLE ELEONOR ROOSEVELT
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00918-2720
Mailing Address - Country:US
Mailing Address - Phone:787-754-0872
Mailing Address - Fax:787-758-9690
Practice Address - Street 1:307 CALLE ELEONOR ROOSEVELT
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00918-2720
Practice Address - Country:US
Practice Address - Phone:787-754-0872
Practice Address - Fax:787-758-9690
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-20
Last Update Date:2014-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR6363103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty