=====================================================
General NPI Number Information
=====================================================
NPI Number | 1134102510
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MUNICIPALITY OF SAN JUAN PR
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/21/2005
-----------------------------------------------------
Last Update Date | 05/17/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | AVE. 65TH INFANTERIA BO. SABANA LLANA
-----------------------------------------------------
City | SAN JUAN
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00929
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-764-9124
-----------------------------------------------------
Fax | 787-764-9904
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 29395
-----------------------------------------------------
City | SAN JUAN
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00929-0395
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-764-9124
-----------------------------------------------------
Fax | 787-764-9904
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | SUB-DIRECTOR
-----------------------------------------------------
Name | MR. GILBERTO GONZALEZ
-----------------------------------------------------
Credential | LIC 1745
-----------------------------------------------------
Telephone | 787-480-3851
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 314000000X
-----------------------------------------------------
Taxonomy Name | Skilled Nursing Facility
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------