Provider Demographics
NPI:1376665174
Name:MUNICIPALITY OF SAN JUAN PR
Entity Type:Organization
Organization Name:MUNICIPALITY OF SAN JUAN PR
Other - Org Name:MUNICIPIO DE SAN JUAN
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SONIA
Authorized Official - Middle Name:
Authorized Official - Last Name:COLLAZO DE JESUS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-480-3003
Mailing Address - Street 1:PO BOX 13964
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00908-3964
Mailing Address - Country:US
Mailing Address - Phone:787-480-3000
Mailing Address - Fax:787-721-7596
Practice Address - Street 1:1306 AVE FERNANDEZ JUNCOS
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00909-2521
Practice Address - Country:US
Practice Address - Phone:787-480-3000
Practice Address - Fax:787-721-7596
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-04
Last Update Date:2016-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
PR17-F16063336I0012X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336I0012XSuppliersPharmacyInstitutional Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2086929OtherPK