Provider Demographics
NPI:1982633012
Name:SAN JUAN CITY HOSPITAL
Entity Type:Organization
Organization Name:SAN JUAN CITY HOSPITAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PEDIATRIC NEPHROLOGY
Authorized Official - Prefix:
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:ARMINDA
Authorized Official - Last Name:GOMEZ-VAZQUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-765-0521
Mailing Address - Street 1:185 COSTA RICA STREET
Mailing Address - Street 2:COND TEIDE APT. 902
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00917-2535
Mailing Address - Country:US
Mailing Address - Phone:787-593-6861
Mailing Address - Fax:
Practice Address - Street 1:SAN JUAN CITY HOSPITAL
Practice Address - Street 2:CENTRO MEDICO
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00928
Practice Address - Country:US
Practice Address - Phone:787-765-7618
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR53412080P0210X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080P0210XAllopathic & Osteopathic PhysiciansPediatricsPediatric NephrologyGroup - Multi-Specialty