Provider Demographics
NPI:1245043470
Name:PSIQUIATRIA PUERTO RICO LLC
Entity type:Organization
Organization Name:PSIQUIATRIA PUERTO RICO LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENTE/PSIQUIATRA
Authorized Official - Prefix:
Authorized Official - First Name:ELVIN
Authorized Official - Middle Name:G
Authorized Official - Last Name:HERNANDEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-658-6868
Mailing Address - Street 1:RR 2 BOX 2650
Mailing Address - Street 2:
Mailing Address - City:ANASCO
Mailing Address - State:PR
Mailing Address - Zip Code:00610-9409
Mailing Address - Country:US
Mailing Address - Phone:787-658-6868
Mailing Address - Fax:
Practice Address - Street 1:MOCA MEDICAL PLAZA SUITE 217
Practice Address - Street 2:CARR 125 KM 5.2
Practice Address - City:MOCA
Practice Address - State:PR
Practice Address - Zip Code:00676
Practice Address - Country:US
Practice Address - Phone:787-658-6868
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-01-30
Last Update Date:2025-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)