Healthcare Provider Details

I. General information

NPI: 1871623108
Provider Name (Legal Business Name): CLINICAS EXTERNA CENTRO ACADEMICO SAN JUAN BAUTISTA,INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/06/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

SALIDA 21 CARRETERA 172 TURABO GARDEN
CAGUAS PR
00725-4968
US

IV. Provider business mailing address

SALIDA 21 CARRETERA 172 P.O. BOX 4968
CAGUAS PR
00725-4968
US

V. Phone/Fax

Practice location:
  • Phone: 178-774-3303
  • Fax: 787-746-3093
Mailing address:
  • Phone: 178-774-3303
  • Fax: 787-746-3093

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. YOCASTA BRUGAL
Title or Position: PRESIDENT
Credential: M.D.
Phone: 17877433038