Provider Demographics
NPI:1124595418
Name:SAN SEBASTIAN ENTERPRISES INC
Entity Type:Organization
Organization Name:SAN SEBASTIAN ENTERPRISES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL SUPERVISOR
Authorized Official - Prefix:MR
Authorized Official - First Name:CARLOS
Authorized Official - Middle Name:M
Authorized Official - Last Name:FIGUEROA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-896-2300
Mailing Address - Street 1:PO BOX 1603
Mailing Address - Street 2:
Mailing Address - City:SAN SEBASTIAN
Mailing Address - State:PR
Mailing Address - Zip Code:00685-1603
Mailing Address - Country:US
Mailing Address - Phone:787-896-2300
Mailing Address - Fax:
Practice Address - Street 1:CARR. 125 KM. 19.1 INT.
Practice Address - Street 2:BO. GUATEMALA
Practice Address - City:SAN SEBASTIAN
Practice Address - State:PR
Practice Address - Zip Code:00685
Practice Address - Country:US
Practice Address - Phone:787-896-2300
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-25
Last Update Date:2018-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR=========OtherTRANSPORTATION MEDICAL APPOINTMENTS
PR=========Medicaid