Provider Demographics
NPI:1831592120
Name:SOCIEDAD DE SALUD MENTAL, LLC
Entity type:Organization
Organization Name:SOCIEDAD DE SALUD MENTAL, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:HIPOLITO
Authorized Official - Middle Name:B
Authorized Official - Last Name:COSTA-PEREZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-467-1007
Mailing Address - Street 1:PO BOX 367631
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00936-7631
Mailing Address - Country:US
Mailing Address - Phone:787-859-4973
Mailing Address - Fax:787-859-5152
Practice Address - Street 1:118 CARR 159 STE 2B
Practice Address - Street 2:ORTIZ MEDICAL PLAZA
Practice Address - City:COROZAL
Practice Address - State:PR
Practice Address - Zip Code:00783-2346
Practice Address - Country:US
Practice Address - Phone:787-859-4973
Practice Address - Fax:787-859-5152
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-01
Last Update Date:2014-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302F00000XManaged Care OrganizationsExclusive Provider Organization