Provider Demographics
NPI:1285820613
Name:ST JUDE MEDICAL PR LLC
Entity Type:Organization
Organization Name:ST JUDE MEDICAL PR LLC
Other - Org Name:ST JUDE MEDICAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SR. ACCOUNTANT
Authorized Official - Prefix:MRS
Authorized Official - First Name:BRENDA
Authorized Official - Middle Name:LIZ
Authorized Official - Last Name:FERNANDEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-641-1111
Mailing Address - Street 1:PO BOX 366105
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00936-6105
Mailing Address - Country:US
Mailing Address - Phone:787-641-1111
Mailing Address - Fax:787-641-1110
Practice Address - Street 1:MUNOZ RIVERA AVE.
Practice Address - Street 2:654 PLAZA SUITE 1402
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00918
Practice Address - Country:US
Practice Address - Phone:787-641-1111
Practice Address - Fax:787-641-1110
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ST. JUDE MEDICAL INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-09-19
Last Update Date:2008-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital