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General NPI Number Information
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NPI Number | 1730582792
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Entity Type | Organization
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Legal Business Name | AFSC OF SAN JUAN, PSC
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Dates
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Enumeration Date | 10/06/2014
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Last Update Date | 10/06/2014
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Provider Practice Location Address
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Address Line | 1413 AVE FERNANDEZ JUNCOS SUITE 1A
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City | SAN JUAN
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State | PR
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Zip | 00909-2649
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Country | US
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Telephone | 787-724-0871
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Fax | 787-724-0886
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Provider Business Mailing Address
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Address Line | PO BOX 19657
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City | SAN JUAN
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State | PR
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Zip | 00910-1657
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Country | US
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Telephone | 787-724-0871
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Fax | 787-724-0886
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Authorized Official
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Title or Position | PRESIDENT
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Name | EGIDIO MONTANILE
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Credential |
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Telephone | 787-724-0871
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QA1903X
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Taxonomy Name | Ambulatory Surgical Clinic/Center
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License Number | 16
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License Number State | PR
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