Basic Information
| Provider Information | |||||||||
| NPI: | 1619161031 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ALEJANDRO | ||||||||
| FirstName: | JORGE | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | |||||||||
| NameSuffix: | SR. | ||||||||
| Credential: | MHA | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 21414 | ||||||||
| Address2: | |||||||||
| City: | SAN JUAN | ||||||||
| State: | PR | ||||||||
| PostalCode: | 009281414 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7877640285 | ||||||||
| FaxNumber: | 7877660940 | ||||||||
| Practice Location | |||||||||
| Address1: | NINTH FLOOR OFFICE 954 | ||||||||
| Address2: | UPR MEDICAL SCIENCES CAMPUS MAIN BUILDING | ||||||||
| City: | SAN JUAN | ||||||||
| State: | PR | ||||||||
| PostalCode: | 009365067 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7877640285 | ||||||||
| FaxNumber: | 7877660940 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/29/2007 | ||||||||
| LastUpdateDate: | 08/29/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QM0855X | Y | Ambulatory Health Care Facilities | Clinic/Center | Adolescent and Children Mental Health |
No ID Information.