Basic Information
| Provider Information | |||||||||
| NPI: | 1992895379 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | INSPIRA PSYCHIATRIC SERVICES PSC | ||||||||
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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: | TORRE AUXILIO MUTUO SUITE 410 | ||||||||
| Address2: | |||||||||
| City: | SAN JUAN | ||||||||
| State: | PR | ||||||||
| PostalCode: | 00917 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7872960555 | ||||||||
| FaxNumber: | 7872960720 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/13/2006 | ||||||||
| LastUpdateDate: | 07/22/2010 | ||||||||
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| AuthorizedOfficialLastName: | VARELA | ||||||||
| AuthorizedOfficialFirstName: | ALVERTO | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 7877040705 | ||||||||
| IsSoleProprietor: | |||||||||
| 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 | CASM0268 | PR | Y | Ambulatory Health Care Facilities | Clinic/Center | Adult Mental Health |
No ID Information.