Healthcare Provider Details

I. General information

NPI: 1003167370
Provider Name (Legal Business Name): SAN JUAN CITY HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/27/2012
Last Update Date: 09/27/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

SAN JUAN CITY HOSPITAL PMB #79 70344SAN
SAN JUAN PR
00936-8344
US

IV. Provider business mailing address

PMB #79 PO BOX 70344
SAN JUAN PR
00936-8344
US

V. Phone/Fax

Practice location:
  • Phone: 939-289-3433
  • Fax:
Mailing address:
  • Phone: 939-289-3433
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code281PC2000X
TaxonomyChildren's Chronic Disease Hospital
License Number9099
License Number StatePR

VIII. Authorized Official

Name: DR. VERONICA DEL RIO
Title or Position: PROGRAM DIRECTOR
Credential:
Phone: 787-630-1582