Healthcare Provider Details

I. General information

NPI: 1619079944
Provider Name (Legal Business Name): SAN JUDAS MEDICAL SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/05/2006
Last Update Date: 10/17/2025
Certification Date: 10/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

AVE ROBERTO CLEMENTE 124-8 VILLA CAROLINA
CAROLINA PR
00985
US

IV. Provider business mailing address

PO BOX 3628
CAROLINA PR
00984-3628
US

V. Phone/Fax

Practice location:
  • Phone: 787-750-4920
  • Fax:
Mailing address:
  • Phone: 787-750-4920
  • Fax: 787-276-4275

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number5799
License Number StatePR
# 2
Primary TaxonomyN
Taxonomy Code133NN1002X
TaxonomyNutrition Education Nutritionist
License Number237
License Number StatePR
# 3
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number10945
License Number StatePR
# 4
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number6414
License Number StatePR
# 6
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number7219
License Number StatePR
# 7
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number16321
License Number StatePR

VIII. Authorized Official

Name: MRS. YOLANDA RAMIREZ
Title or Position: SUPERVISORA
Credential:
Phone: 787-750-5245