Healthcare Provider Details

I. General information

NPI: 1629172747
Provider Name (Legal Business Name): GRUPO EMPRESAS DE SALUD DE S J
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/11/2006
Last Update Date: 08/12/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

AVE JESUS T PINERO ESQ. MOLINILLO
CAROLINA PR
00985
US

IV. Provider business mailing address

CALLE CESAR GONZALEZ 480 URB ROOSEVELT
SAN JUAN PR
00919
US

V. Phone/Fax

Practice location:
  • Phone: 787-767-8758
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code146D00000X
TaxonomyPersonal Emergency Response Attendant
License Number
License Number State

VIII. Authorized Official

Name: RAUL VILLALOBOS
Title or Position: PRESIDENT
Credential: MD
Phone: 787-767-8758