Healthcare Provider Details

I. General information

NPI: 1134102510
Provider Name (Legal Business Name): MUNICIPALITY OF SAN JUAN PR
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/21/2005
Last Update Date: 05/17/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

AVE. 65TH INFANTERIA 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 Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State

VIII. Authorized Official

Name: MR. GILBERTO GONZALEZ
Title or Position: SUB-DIRECTOR
Credential: LIC 1745
Phone: 787-480-3851