Healthcare Provider Details

I. General information

NPI: 1194141812
Provider Name (Legal Business Name): MUNICIPALITY OF SAN JUAN
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/06/2014
Last Update Date: 03/06/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CALLE CERRA FINAL #900
SAN JUAN PR
00928-1405
US

IV. Provider business mailing address

CALLE CERRA FINAL #900
SAN JUAN PR
00928-1405
US

V. Phone/Fax

Practice location:
  • Phone: 787-480-3845
  • Fax: 787-977-8405
Mailing address:
  • Phone: 787-480-3845
  • Fax: 787-977-8401

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number101
License Number StatePR

VIII. Authorized Official

Name: MRS. JOCELYN PADIN
Title or Position: ADMINISTRATOR
Credential:
Phone: 787-480-3845