Provider Demographics
NPI:1003961285
Name:ASOCIACION DE MAESTROS DE P R
Entity Type:Organization
Organization Name:ASOCIACION DE MAESTROS DE P R
Other - Org Name:PROSSAM (TEACHERS ASSOCIATION HEALTH SERVICES PROGRAM
Other - Org Type:Other Name
Authorized Official - Title/Position:ADMINISTRATIVE ASISTANT
Authorized Official - Prefix:
Authorized Official - First Name:JAVIER
Authorized Official - Middle Name:
Authorized Official - Last Name:BARRETO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-763-5560
Mailing Address - Street 1:PO BOX 191088
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00919-1088
Mailing Address - Country:US
Mailing Address - Phone:787-753-8591
Mailing Address - Fax:787-754-8854
Practice Address - Street 1:#550 SERGIO CUEVAS BUSTAMANTE ST.
Practice Address - Street 2:
Practice Address - City:HATO REY
Practice Address - State:PR
Practice Address - Zip Code:00918
Practice Address - Country:US
Practice Address - Phone:787-763-5560
Practice Address - Fax:787-767-6600
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-25
Last Update Date:2023-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR0010098Medicare PIN