=====================================================
General NPI Number Information
=====================================================
NPI Number | 1841271418
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SAN JUAN AGING
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/09/2005
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | AVE. 65TH INFANTERY 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 | EXECUTIVE DIRECTOR
-----------------------------------------------------
Name | MS. MARITZA VEGA
-----------------------------------------------------
Credential | MBA/HCM
-----------------------------------------------------
Telephone | 787-764-9124
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 273Y00000X
-----------------------------------------------------
Taxonomy Name | Rehabilitation Hospital Unit
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------