Provider Demographics
NPI:1396711198
Name:SAN JUAN MEDICAL ASSOC PSC
Entity type:Organization
Organization Name:SAN JUAN MEDICAL ASSOC PSC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:EUGENIA
Authorized Official - Last Name:ZWEIG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-766-1081
Mailing Address - Street 1:RVDO DOMINGO MARRERO NAVARRO STREET
Mailing Address - Street 2:NUM 4
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00925
Mailing Address - Country:US
Mailing Address - Phone:787-766-1081
Mailing Address - Fax:787-282-0869
Practice Address - Street 1:RVDO DOMINGO MARRERO NAVARRO STREET
Practice Address - Street 2:NUM 4
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00925-0000
Practice Address - Country:US
Practice Address - Phone:787-766-1081
Practice Address - Fax:787-282-0869
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-23
Last Update Date:2024-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR82703Medicare ID - Type UnspecifiedSAN JUAN MEDICAL ASSOC PS