Provider Demographics
NPI:1841271418
Name:SAN JUAN AGING
Entity type:Organization
Organization Name:SAN JUAN AGING
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:MARITZA
Authorized Official - Middle Name:
Authorized Official - Last Name:VEGA
Authorized Official - Suffix:
Authorized Official - Credentials:MBA/HCM
Authorized Official - Phone:787-764-9124
Mailing Address - Street 1:PO BOX 29395
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00929-0395
Mailing Address - Country:US
Mailing Address - Phone:787-764-9124
Mailing Address - Fax:787-764-9904
Practice Address - Street 1:AVE. 65TH INFANTERY BO. SABANA LLANA
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00929
Practice Address - Country:US
Practice Address - Phone:787-764-9124
Practice Address - Fax:787-764-9904
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes273Y00000XHospital UnitsRehabilitation Unit
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR2501325OtherACCA
PR407004OtherHOME CARE
PR40081OtherPREFERRED MEDICARE CHOICE
PR4500121OtherACCA
PR001365OtherAMERICAN HEALTH
PR820953OtherMMM
PR9900144OtherACCA
PRP113OtherFIRST MEDICAL
PR68650-41041OtherCRUZ AZUL
PRP113OtherFIRST MEDICAL
PR2501325OtherACCA