Healthcare Provider Details

I. General information

NPI: 1023443355
Provider Name (Legal Business Name): MUNICIPALITY OF SAN JUAN
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/05/2013
Last Update Date: 09/05/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CALLE CERRA FINAL #900
SAN JUAN PR
00928
US

IV. Provider business mailing address

PO BOX 21405
SAN JUAN PR
00928-1405
US

V. Phone/Fax

Practice location:
  • Phone: 787-480-3841
  • Fax: 787-977-8401
Mailing address:
  • Phone: 787-480-3841
  • Fax: 787-977-8401

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License NumberCNC 78- 262
License Number StatePR

VIII. Authorized Official

Name: MR. GILBERTO GONZALEZ AVILES
Title or Position: SUB-DIRECTOR
Credential: LIC
Phone: 787-480-3841