Healthcare Provider Details

I. General information

NPI: 1295000347
Provider Name (Legal Business Name): SAN JUAN AGING CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/21/2012
Last Update Date: 03/21/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1187 CALLE 46 SE URBANIZACION REPARTO METROPOLITANO
SAN JUAN PR
00921-2625
US

IV. Provider business mailing address

1187 CALLE 46 SE REPARTO METROPOLITANO
SAN JUAN PR
00921-2625
US

V. Phone/Fax

Practice location:
  • Phone: 787-480-5402
  • Fax: 787-764-9904
Mailing address:
  • Phone: 787-480-5402
  • Fax: 787-649-9904

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code311ZA0620X
TaxonomyAdult Care Home Facility
License Number25487
License Number StatePR

VIII. Authorized Official

Name: DR. JOSEFA COTTO
Title or Position: SUP. DEP DE FACTURACION
Credential:
Phone: 787-480-3876