Basic Information
| Provider Information | |||||||||
| NPI: | 1801262183 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | INSPIRA MENTAL HEALTH MANAGEMENT | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 9809 | ||||||||
| Address2: | |||||||||
| City: | CAGUAS | ||||||||
| State: | PR | ||||||||
| PostalCode: | 007269809 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7877040705 | ||||||||
| FaxNumber: | 7877447444 | ||||||||
| Practice Location | |||||||||
| Address1: | CONSOLIDATED MALL B5 | ||||||||
| Address2: | AVE. GAUTIER BENITEZ 202 | ||||||||
| City: | CAGUAS | ||||||||
| State: | PUERTO RICO | ||||||||
| PostalCode: | 00725 | ||||||||
| CountryCode: | UM | ||||||||
| TelephoneNumber: | 7877040705 | ||||||||
| FaxNumber: | 7877447444 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/20/2015 | ||||||||
| LastUpdateDate: | 08/20/2015 | ||||||||
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| AuthorizedOfficialLastName: | VARELA | ||||||||
| AuthorizedOfficialFirstName: | ALBERTO | ||||||||
| AuthorizedOfficialMiddleName: | M | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENTE | ||||||||
| AuthorizedOfficialTelephone: | 7877040705 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QM0850X | 95150 | PR | Y | Ambulatory Health Care Facilities | Clinic/Center | Adult Mental Health |
No ID Information.