Healthcare Provider Details

I. General information

NPI: 1699025726
Provider Name (Legal Business Name): SAN JUAN HEALTHCARE-HOMELESS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/17/2012
Last Update Date: 03/25/2022
Certification Date: 03/16/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 CALLE CERRA FINAL ESQUINA CALLE HOARE
SAN JUAN PR
00907-5104
US

IV. Provider business mailing address

PO BOX 21405
SAN JUAN PR
00928-1405
US

V. Phone/Fax

Practice location:
  • Phone: 787-480-3821
  • Fax:
Mailing address:
  • Phone: 787-480-3876
  • Fax: 787-977-8401

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QC1500X
TaxonomyCommunity Health Clinic/Center
License Number101
License Number StatePR

VIII. Authorized Official

Name: DR. LUIS V CLAS
Title or Position: DIRECTOR/CEO
Credential:
Phone: 787-480-3838