Healthcare Provider Details

I. General information

NPI: 1023099793
Provider Name (Legal Business Name): SAN JUAN AGING CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/09/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

AVE. 65 INFANTERY BO. SABANA LLANA
SAN JUAN PR
00929
US

IV. Provider business mailing address

PO BOX 29395
SAN JUAN PR
00929-0395
US

V. Phone/Fax

Practice location:
  • Phone: 787-764-9124
  • Fax: 787-764-9904
Mailing address:
  • Phone: 787-764-9124
  • Fax: 787-764-9904

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code313M00000X
TaxonomyNursing Facility/Intermediate Care Facility
License Number
License Number State

VIII. Authorized Official

Name: MS. MARITZA VEGA
Title or Position: EXECUTIVE DIRECTOR
Credential: MBA/HCM
Phone: 787-764-9124