Healthcare Provider Details

I. General information

NPI: 1962712075
Provider Name (Legal Business Name): MUNICIPIO DE SAN JUAN
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/08/2010
Last Update Date: 10/08/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

#906 CALLE CERRA
SANTURCE PR
00907
US

IV. Provider business mailing address

CALLE CERRA
SANTURCE PUERTO RICO
00907
UM

V. Phone/Fax

Practice location:
  • Phone: 787-480-3792
  • Fax: 787-723-6247
Mailing address:
  • Phone: 787-480-3792
  • Fax: 787-723-6247

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number5943
License Number StatePR

VIII. Authorized Official

Name: MRS. KAREN RAQUEL CARDONA
Title or Position: TRABAJADOR SOCIAL
Credential: 4953
Phone: 787-480-3792