Provider Demographics
NPI:1265796635
Name:CASA JOVEN DEL CARIBE, INC.
Entity type:Organization
Organization Name:CASA JOVEN DEL CARIBE, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR DE SERVICIOS MEDICOS
Authorized Official - Prefix:MR
Authorized Official - First Name:SAMUEL
Authorized Official - Middle Name:
Authorized Official - Last Name:AGOSTO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-644-0194
Mailing Address - Street 1:CALLE EXTENSION SUR #527
Mailing Address - Street 2:
Mailing Address - City:DORADO
Mailing Address - State:PUERTO RICO
Mailing Address - Zip Code:00646
Mailing Address - Country:UM
Mailing Address - Phone:787-796-2832
Mailing Address - Fax:787-796-2832
Practice Address - Street 1:CALLE EXTENSION SUR #537
Practice Address - Street 2:
Practice Address - City:DORADO
Practice Address - State:PR
Practice Address - Zip Code:00646-0694
Practice Address - Country:US
Practice Address - Phone:787-796-2832
Practice Address - Fax:787-796-2832
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-29
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR3336C0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0002XSuppliersPharmacyClinic Pharmacy