Healthcare Provider Details

I. General information

NPI: 1669661708
Provider Name (Legal Business Name): MUNICIPALITY OF SAN JUAN PR
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/15/2007
Last Update Date: 09/23/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

AVE BORINQUEN ESQ CALLE NIN BO OBRERO
SAN JUAN PR
00915
US

IV. Provider business mailing address

PO BOX 21405
SAN JUAN PR
00928-1405
US

V. Phone/Fax

Practice location:
  • Phone: 787-480-5040
  • Fax: 787-977-8401
Mailing address:
  • Phone: 787-480-3876
  • Fax: 787-977-8401

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336M0003X
TaxonomyManaged Care Organization Pharmacy
License Number17F2555
License Number StatePR

VIII. Authorized Official

Name: JULIO RAMOS
Title or Position: ADMINISTRATOR
Credential:
Phone: 787-480-5040