Provider Demographics
NPI:1639494644
Name:SAINT JUST MEDICAL
Entity Type:Organization
Organization Name:SAINT JUST MEDICAL
Other - Org Name:SAME
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CARMEN
Authorized Official - Middle Name:
Authorized Official - Last Name:LOPEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-637-4449
Mailing Address - Street 1:VILLAS DE RIO GRANDE
Mailing Address - Street 2:CALLE 4 L 1
Mailing Address - City:RIO GRANDE
Mailing Address - State:PR
Mailing Address - Zip Code:00745-0000
Mailing Address - Country:US
Mailing Address - Phone:787-755-5696
Mailing Address - Fax:787-887-4045
Practice Address - Street 1:CARR 848
Practice Address - Street 2:URB NUESTRA SENORA DE LOURDES B 24
Practice Address - City:TRUJILLO ALTO
Practice Address - State:PR
Practice Address - Zip Code:00976-3010
Practice Address - Country:US
Practice Address - Phone:787-755-5696
Practice Address - Fax:787-887-4045
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-01
Last Update Date:2010-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR172591261QC1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QC1800XAmbulatory Health Care FacilitiesClinic/CenterCorporate Health