Provider Demographics
NPI:1952583072
Name:GRUPO DE EMPRESAS DE SALUD DE SAN JUAN, INC.
Entity Type:Organization
Organization Name:GRUPO DE EMPRESAS DE SALUD DE SAN JUAN, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RAUL
Authorized Official - Middle Name:
Authorized Official - Last Name:VILLALOBOS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-767-8758
Mailing Address - Street 1:PO BOX 193044
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00919-3044
Mailing Address - Country:US
Mailing Address - Phone:787-767-8758
Mailing Address - Fax:
Practice Address - Street 1:CALLE CARILE 130
Practice Address - Street 2:EXPRESO TRUJILLO ALTO
Practice Address - City:TRUJILLO ALTO
Practice Address - State:PR
Practice Address - Zip Code:00976
Practice Address - Country:US
Practice Address - Phone:787-767-8758
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LABORATORIO
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-11-30
Last Update Date:2007-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
31171OtherPROVIDER NUMBER
31171Medicare PIN