Provider Demographics
NPI:1407070600
Name:SAN JUAN MEDICS
Entity Type:Organization
Organization Name:SAN JUAN MEDICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JULIO
Authorized Official - Middle Name:
Authorized Official - Last Name:SANTIAGO CARTAGENA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-765-2423
Mailing Address - Street 1:URB CORRIENTES
Mailing Address - Street 2:RIO LA PLATA CO51
Mailing Address - City:TRUJILLO ALTO
Mailing Address - State:PR
Mailing Address - Zip Code:00976
Mailing Address - Country:US
Mailing Address - Phone:787-765-2423
Mailing Address - Fax:787-765-2423
Practice Address - Street 1:EDIFICIO NATIONAL PLAZA
Practice Address - Street 2:OFICINA 302
Practice Address - City:HATO REY
Practice Address - State:PR
Practice Address - Zip Code:00918
Practice Address - Country:US
Practice Address - Phone:787-765-2423
Practice Address - Fax:787-765-2423
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR10437207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR=========OtherPATRONAL IDENTIFICATION