Healthcare Provider Details

I. General information

NPI: 1730582792
Provider Name (Legal Business Name): AFSC OF SAN JUAN, PSC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/06/2014
Last Update Date: 10/06/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1413 AVE FERNANDEZ JUNCOS SUITE 1A
SAN JUAN PR
00909-2649
US

IV. Provider business mailing address

PO BOX 19657
SAN JUAN PR
00910-1657
US

V. Phone/Fax

Practice location:
  • Phone: 787-724-0871
  • Fax: 787-724-0886
Mailing address:
  • Phone: 787-724-0871
  • Fax: 787-724-0886

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number16
License Number StatePR

VIII. Authorized Official

Name: EGIDIO MONTANILE
Title or Position: PRESIDENT
Credential:
Phone: 787-724-0871