Provider Demographics
NPI:1902256456
Name:CENTRO DE SALUD MENTAL DEL OESTE
Entity Type:Organization
Organization Name:CENTRO DE SALUD MENTAL DEL OESTE
Other - Org Name:CSMDO
Other - Org Type:Other Name
Authorized Official - Title/Position:PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:THAIZ
Authorized Official - Middle Name:
Authorized Official - Last Name:RIVERA
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:787-517-9298
Mailing Address - Street 1:HC 4 BOX 13482
Mailing Address - Street 2:
Mailing Address - City:SAN GERMAN
Mailing Address - State:PR
Mailing Address - Zip Code:00683-9568
Mailing Address - Country:US
Mailing Address - Phone:787-517-9298
Mailing Address - Fax:
Practice Address - Street 1:HC 4 BOX 13482
Practice Address - Street 2:
Practice Address - City:SAN GERMAN
Practice Address - State:PR
Practice Address - Zip Code:00683-9568
Practice Address - Country:US
Practice Address - Phone:787-517-9298
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-15
Last Update Date:2016-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR261QM0801X, 261QM0850X, 261QM0855X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR1780006155OtherNPI
PRGT591AOtherPTAN