Healthcare Provider Details

I. General information

NPI: 1275801029
Provider Name (Legal Business Name): SAN JUAN VAMC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/08/2011
Last Update Date: 03/28/2023
Certification Date: 03/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

BUILDING LOT #3 PR-3 KM 54.9, PUEBLO WARD
CEIBA PR
00735-9998
US

IV. Provider business mailing address

PO BOX 94469
CLEVELAND OH
44101-4469
US

V. Phone/Fax

Practice location:
  • Phone: 866-793-4591
  • Fax:
Mailing address:
  • Phone: 866-793-4591
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QV0200X
TaxonomyVA Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MRS. ERIN POTTER
Title or Position: NPI TEAM MEMBER
Credential:
Phone: 202-382-2579