Provider Demographics
NPI:1487675096
Name:GRUPO DE EMPRESAS DE SALUD DE SAN JUAN, INC
Entity Type:Organization
Organization Name:GRUPO DE EMPRESAS DE SALUD DE SAN JUAN, INC
Other - Org Name:GRUPO EMPRESAS DE SALUD
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT & CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:RAUL
Authorized Official - Middle Name:
Authorized Official - Last Name:VILLALOBOS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-767-8758
Mailing Address - Street 1:P.O. BOX 193044
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00919-3044
Mailing Address - Country:US
Mailing Address - Phone:787-767-8758
Mailing Address - Fax:787-250-9265
Practice Address - Street 1:CALLE PADRE LAS CASAS #107
Practice Address - Street 2:UR. EL VEDADO
Practice Address - City:HATO REY
Practice Address - State:PR
Practice Address - Zip Code:00918
Practice Address - Country:US
Practice Address - Phone:787-294-7801
Practice Address - Fax:787-294-7801
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-21
Last Update Date:2011-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes146M00000XEmergency Medical Service ProvidersEmergency Medical Technician, IntermediateGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
0083905Medicare ID - Type Unspecified