Provider Demographics
NPI:1093762650
Name:MUNICIPALITY OF SAN JUAN PR
Entity Type:Organization
Organization Name:MUNICIPALITY OF SAN JUAN PR
Other - Org Name:EMERGENCIAS MEDICAS DE SAN JUAN
Other - Org Type:Other Name
Authorized Official - Title/Position:DIRECTOR EJECUTIVO
Authorized Official - Prefix:
Authorized Official - First Name:CARLOS
Authorized Official - Middle Name:A
Authorized Official - Last Name:ACEVEDO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-765-4881
Mailing Address - Street 1:PO BOX 70179
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00936-8179
Mailing Address - Country:US
Mailing Address - Phone:787-765-4881
Mailing Address - Fax:787-753-9109
Practice Address - Street 1:COND DE DIEGO
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00923-3001
Practice Address - Country:US
Practice Address - Phone:787-765-4881
Practice Address - Fax:787-753-9109
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-28
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PRTCAMB2403416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR9002782OtherACAA
PR=========1WOtherMCS-HMO
PR0059240Medicare ID - Type Unspecified