Healthcare Provider Details

I. General information

NPI: 1093434136
Provider Name (Legal Business Name): SAN LUCAS METRO, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/23/2022
Last Update Date: 04/05/2024
Certification Date: 04/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CARR 844, KM .5 CUPEY
SAN JUAN PR
00928-4153
US

IV. Provider business mailing address

RR 9 BOX 6000
SAN JUAN PR
00926-9816
US

V. Phone/Fax

Practice location:
  • Phone: 787-761-8383
  • Fax:
Mailing address:
  • Phone: 787-761-8383
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State

VIII. Authorized Official

Name: MRS. ROSEMARY DE LA CRUZ SEVERINO
Title or Position: PRINCIPAL FINANCE OFFICER
Credential:
Phone: 787-864-4300