Provider Demographics
NPI:1497635551
Name:MPR FIVE TWELVE PARK LLC
Entity type:Organization
Organization Name:MPR FIVE TWELVE PARK LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRADORA
Authorized Official - Prefix:MS
Authorized Official - First Name:MARIEVA
Authorized Official - Middle Name:
Authorized Official - Last Name:PUIG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-974-2211
Mailing Address - Street 1:VILLA ANDALUCIA SUITES # 2A
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00926-2378
Mailing Address - Country:US
Mailing Address - Phone:787-974-2211
Mailing Address - Fax:
Practice Address - Street 1:VILLA ANDALUCIA SUITES # 2A
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00926-2378
Practice Address - Country:US
Practice Address - Phone:787-974-2211
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-09-08
Last Update Date:2025-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty