Provider Demographics
NPI:1902179807
Name:JUNTA DEL CENTRO DR JOSE S BELAVAL
Entity Type:Organization
Organization Name:JUNTA DEL CENTRO DR JOSE S BELAVAL
Other - Org Name:HEALTHPROMED SAN JUAN DENTAL
Other - Org Type:Other Name
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JULIA
Authorized Official - Middle Name:M
Authorized Official - Last Name:VELEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-268-4171
Mailing Address - Street 1:PO BOX 14457
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00916-2011
Mailing Address - Country:US
Mailing Address - Phone:787-268-4171
Mailing Address - Fax:
Practice Address - Street 1:2003 AVENIDA BORINQUEN
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00916-3814
Practice Address - Country:US
Practice Address - Phone:787-268-4171
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-23
Last Update Date:2012-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR24711223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty