Healthcare Provider Details

I. General information

NPI: 1437491289
Provider Name (Legal Business Name): ESCUELA DE MEDICINA SAN JUAN BAUTISTA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/20/2013
Last Update Date: 03/20/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CARRETERA 172 URBANIZACION TURABO GARDENS
CAGUAS PR
00726-4968
US

IV. Provider business mailing address

PO BOX 4968
CAGUAS PR
00726-4968
US

V. Phone/Fax

Practice location:
  • Phone: 787-743-3038
  • Fax:
Mailing address:
  • Phone: 787-743-3038
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number StatePR

VIII. Authorized Official

Name: DR. YUCASTA BRUGAL
Title or Position: PRESIDENTA
Credential: M.D.
Phone: 787-743-3038