Provider Demographics
NPI:1881029379
Name:MUNICIPALITY OF SAN JUAN
Entity Type:Organization
Organization Name:MUNICIPALITY OF SAN JUAN
Other - Org Name:GRUPO PEDIATRICO CDT DR.GUALBERTO RABELL CASA CUNA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SUB-DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:GILBERTO
Authorized Official - Middle Name:GONZALEZ
Authorized Official - Last Name:AVILES
Authorized Official - Suffix:
Authorized Official - Credentials:LIC
Authorized Official - Phone:787-480-3841
Mailing Address - Street 1:PO BOX 21405
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00928-1405
Mailing Address - Country:US
Mailing Address - Phone:787-480-3841
Mailing Address - Fax:787-977-0544
Practice Address - Street 1:CALLE CERRA FINAL #900
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00928
Practice Address - Country:US
Practice Address - Phone:787-480-3841
Practice Address - Fax:787-977-0544
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-04
Last Update Date:2013-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PRCNC 78-262261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR400015Medicare PIN