Healthcare Provider Details

I. General information

NPI: 1205386554
Provider Name (Legal Business Name): MUNICIPIO DE SAN JUAN
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/11/2016
Last Update Date: 10/11/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1306 AVE FERNANDEZ JUNCOS PARADA 19 SANTURCE
SAN JUAN PR
00909-2521
US

IV. Provider business mailing address

1306 AVE FERNANDEZ JUNCOS PDA 19 SANTURCE
SAN JUAN PR
00909-2521
US

V. Phone/Fax

Practice location:
  • Phone: 178-748-0300
  • Fax: 787-722-2220
Mailing address:
  • Phone: 787-480-3000
  • Fax: 787-722-2220

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number987
License Number StatePR

VIII. Authorized Official

Name: MRS. EDIVETTE SOTO
Title or Position: NUTRITIONIST
Credential:
Phone: 787-480-3000