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General NPI Number Information
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NPI Number | 1215294343
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Entity Type | Organization
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Legal Business Name | CASA JOVEN DEL CARIBE, INC.
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Dates
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Enumeration Date | 04/13/2012
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Last Update Date | 04/13/2012
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Provider Practice Location Address
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Address Line | 537 CALLE EXT S
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City | DORADO
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State | PR
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Zip | 00646-5016
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Country | US
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Telephone | 787-796-2832
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Fax | 787-796-2832
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Provider Business Mailing Address
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Address Line | PO BOX 694
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City | DORADO
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State | PR
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Zip | 00646-0694
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Country | US
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Telephone | 787-796-2832
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Fax | 787-796-2832
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Authorized Official
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Title or Position | DIRECTOR SERVICIOS CLINICOS
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Name | MR. SAMUEL AGOSTO LOPEZ
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Credential |
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Telephone | 787-644-0194
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM2500X
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Taxonomy Name | Medical Specialty Clinic/Center
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License Number | 16726
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License Number State | PR
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