Healthcare Provider Details

I. General information

NPI: 1043412752
Provider Name (Legal Business Name): SAN JORGE CHILDREN'S MEDICAL SPECIALTIES,PSC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/04/2007
Last Update Date: 04/24/2026
Certification Date: 04/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

252 CALLE SAN JORGE
SAN JUAN PR
00912-3239
US

IV. Provider business mailing address

252 CALLE SAN JORGE
SAN JUAN PR
00912-3239
US

V. Phone/Fax

Practice location:
  • Phone: 787-728-1575
  • Fax: 787-726-0402
Mailing address:
  • Phone: 787-728-1575
  • Fax: 787-726-0402

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2080P0207X
TaxonomyPediatric Hematology & Oncology Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QX0200X
TaxonomyOncology Clinic/Center
License Number05-B-1068
License Number StatePR

VIII. Authorized Official

Name: DR. LUIS A. CLAVELL
Title or Position: DIRECTOR
Credential: M.D.
Phone: 787-728-1575