Healthcare Provider Details

I. General information

NPI: 1427124130
Provider Name (Legal Business Name): MUNICIPIO DE JAYUYA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/27/2006
Last Update Date: 08/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 CALLE CEMENTERIO
JAYUYA PR
00664-1452
US

IV. Provider business mailing address

2 CALLE CEMENTERIO P O BOX 488
JAYUYA PR
00664-1452
US

V. Phone/Fax

Practice location:
  • Phone: 787-828-0259
  • Fax: 787-828-0259
Mailing address:
  • Phone: 787-828-0919
  • Fax: 787-828-0259

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QV0200X
TaxonomyVA Clinic/Center
License Number9164
License Number StatePR

VIII. Authorized Official

Name: MRS. WANDA ZAMORA
Title or Position: ADMINISTRATOR
Credential:
Phone: 787-828-0919