Healthcare Provider Details

I. General information

NPI: 1376665174
Provider Name (Legal Business Name): MUNICIPALITY OF SAN JUAN PR
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/04/2007
Last Update Date: 01/22/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1306 AVE FERNANDEZ JUNCOS
SAN JUAN PR
00909-2521
US

IV. Provider business mailing address

PO BOX 13964
SAN JUAN PR
00908-3964
US

V. Phone/Fax

Practice location:
  • Phone: 787-480-3000
  • Fax: 787-721-7596
Mailing address:
  • Phone: 787-480-3000
  • Fax: 787-721-7596

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336I0012X
TaxonomyInstitutional Pharmacy
License Number17-F1606
License Number StatePR

VIII. Authorized Official

Name: SONIA COLLAZO DE JESUS
Title or Position: MANAGER
Credential:
Phone: 787-480-3003