Provider Demographics
NPI:1194141812
Name:MUNICIPALITY OF SAN JUAN
Entity type:Organization
Organization Name:MUNICIPALITY OF SAN JUAN
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:JOCELYN
Authorized Official - Middle Name:
Authorized Official - Last Name:PADIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-480-3845
Mailing Address - Street 1:CALLE CERRA FINAL #900
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00928-1405
Mailing Address - Country:US
Mailing Address - Phone:787-480-3845
Mailing Address - Fax:787-977-8401
Practice Address - Street 1:CALLE CERRA FINAL #900
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00928-1405
Practice Address - Country:US
Practice Address - Phone:787-480-3845
Practice Address - Fax:787-977-8405
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MUNICIPALITY OF SAN JUAN
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-03-06
Last Update Date:2014-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR101261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR400015Medicare UPIN