Healthcare Provider Details

I. General information

NPI: 1093762650
Provider Name (Legal Business Name): MUNICIPALITY OF SAN JUAN PR
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/28/2006
Last Update Date: 07/21/2022
Certification Date: 05/16/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

COND DE DIEGO
SAN JUAN PR
00923-3001
US

IV. Provider business mailing address

PO BOX 70179
SAN JUAN PR
00936-8179
US

V. Phone/Fax

Practice location:
  • Phone: 787-765-4881
  • Fax: 787-753-9109
Mailing address:
  • Phone: 787-765-4881
  • Fax: 787-753-9109

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License NumberTCAMB240
License Number StatePR

VIII. Authorized Official

Name: CARLOS A ACEVEDO
Title or Position: DIRECTOR EJECUTIVO
Credential:
Phone: 787-765-4881