Provider Demographics
NPI:1528486164
Name:GRUPO SALUD MENTAL DEL SUR, INC.
Entity type:Organization
Organization Name:GRUPO SALUD MENTAL DEL SUR, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSE
Authorized Official - Middle Name:X
Authorized Official - Last Name:VAZQUEZ
Authorized Official - Suffix:SR
Authorized Official - Credentials:
Authorized Official - Phone:787-638-3090
Mailing Address - Street 1:1306 CALLE SALUD
Mailing Address - Street 2:ESQ CAMPECHE
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00717-1692
Mailing Address - Country:US
Mailing Address - Phone:787-638-3090
Mailing Address - Fax:787-259-3331
Practice Address - Street 1:609 AVE TITO CASTRO SUITES 102
Practice Address - Street 2:PMB 229
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00716-1692
Practice Address - Country:US
Practice Address - Phone:787-638-3090
Practice Address - Fax:787-259-3331
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-01
Last Update Date:2014-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health