Healthcare Provider Details

I. General information

NPI: 1518309848
Provider Name (Legal Business Name): MUNICIPIO DE SAN JUAN
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/29/2013
Last Update Date: 07/29/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CALLE SERRA 900 GUALBERTO RABELL
SAN JUAN PR
00907
US

IV. Provider business mailing address

CALLE SERRA 900
SAN JUAN PR
00907
US

V. Phone/Fax

Practice location:
  • Phone: 787-480-3828
  • Fax:
Mailing address:
  • Phone: 787-480-3828
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. ELLIOTT SANTIAGO
Title or Position: DIRECTOR PROGRAMA SALUD MENTAL
Credential: PHD, MPH
Phone: 787-480-3600