Provider Demographics
NPI:1215294343
Name:CASA JOVEN DEL CARIBE, INC.
Entity type:Organization
Organization Name:CASA JOVEN DEL CARIBE, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR SERVICIOS CLINICOS
Authorized Official - Prefix:MR
Authorized Official - First Name:SAMUEL
Authorized Official - Middle Name:
Authorized Official - Last Name:AGOSTO LOPEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-644-0194
Mailing Address - Street 1:PO BOX 694
Mailing Address - Street 2:
Mailing Address - City:DORADO
Mailing Address - State:PR
Mailing Address - Zip Code:00646-0694
Mailing Address - Country:US
Mailing Address - Phone:787-796-2832
Mailing Address - Fax:787-796-2832
Practice Address - Street 1:537 CALLE EXT S
Practice Address - Street 2:
Practice Address - City:DORADO
Practice Address - State:PR
Practice Address - Zip Code:00646-5016
Practice Address - Country:US
Practice Address - Phone:787-796-2832
Practice Address - Fax:787-796-2832
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-13
Last Update Date:2012-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR16726261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty