Provider Demographics
NPI:1043439383
Name:CLINICA SERVICIOS INTEGRALES PARA LA NINEZ Y ADOLESCENCIA DE SAN JUAN
Entity type:Organization
Organization Name:CLINICA SERVICIOS INTEGRALES PARA LA NINEZ Y ADOLESCENCIA DE SAN JUAN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:NITZA
Authorized Official - Middle Name:
Authorized Official - Last Name:OTERO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-721-3220
Mailing Address - Street 1:900 CALLE CERRA
Mailing Address - Street 2:
Mailing Address - City:SANTURCE
Mailing Address - State:PR
Mailing Address - Zip Code:00907-5104
Mailing Address - Country:US
Mailing Address - Phone:787-721-3220
Mailing Address - Fax:787-721-3207
Practice Address - Street 1:900 CALLE CERRA
Practice Address - Street 2:
Practice Address - City:SANTURCE
Practice Address - State:PR
Practice Address - Zip Code:00907-5104
Practice Address - Country:US
Practice Address - Phone:787-721-3220
Practice Address - Fax:787-721-3207
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR261QM0855X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health