Provider Demographics
NPI:1588983647
Name:CLINICA DE SALUD MENTAL DE LA COMUNIDAD
Entity type:Organization
Organization Name:CLINICA DE SALUD MENTAL DE LA COMUNIDAD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ILEANA
Authorized Official - Middle Name:
Authorized Official - Last Name:RODRIGUEZ-GARCIA
Authorized Official - Suffix:
Authorized Official - Credentials:EDD
Authorized Official - Phone:787-725-6500
Mailing Address - Street 1:PO BOX 9023711
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00902-3711
Mailing Address - Country:US
Mailing Address - Phone:787-725-6500
Mailing Address - Fax:787-977-4833
Practice Address - Street 1:151 CALLE TANCA
Practice Address - Street 2:OLD SAN JUAN
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00901-1412
Practice Address - Country:US
Practice Address - Phone:787-725-6500
Practice Address - Fax:787-977-4833
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-27
Last Update Date:2013-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR32559251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health