Provider Demographics
NPI:1558452755
Name:JUVENIA MEDICAL CENTER CSP
Entity Type:Organization
Organization Name:JUVENIA MEDICAL CENTER CSP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ANGEL
Authorized Official - Middle Name:LUIS
Authorized Official - Last Name:CASTANEDA-RUEDA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-204-7194
Mailing Address - Street 1:LA FUENTE TOWN CENTER, 706 CALLE MARGINAL
Mailing Address - Street 2:SUITE 11120
Mailing Address - City:GUAYAM
Mailing Address - State:PR
Mailing Address - Zip Code:00784
Mailing Address - Country:US
Mailing Address - Phone:787-204-7194
Mailing Address - Fax:
Practice Address - Street 1:LA FUENTE TOWN CENTER, 706 CALLE MARGINAL
Practice Address - Street 2:SUITE 11120
Practice Address - City:GUAYAM
Practice Address - State:PR
Practice Address - Zip Code:00784
Practice Address - Country:US
Practice Address - Phone:787-204-7194
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty