Provider Demographics
NPI:1982815437
Name:PROGRAMA SIDA DE SAN JUAN
Entity Type:Organization
Organization Name:PROGRAMA SIDA DE SAN JUAN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:AMAURY
Authorized Official - Middle Name:
Authorized Official - Last Name:LLUVERAS
Authorized Official - Suffix:
Authorized Official - Credentials:LIC
Authorized Official - Phone:787-480-3000
Mailing Address - Street 1:PO BOX 21405
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00928-1405
Mailing Address - Country:US
Mailing Address - Phone:787-480-3000
Mailing Address - Fax:787-724-5104
Practice Address - Street 1:1306 AVE FERNANDEZ JUNCOS
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00909-2521
Practice Address - Country:US
Practice Address - Phone:787-723-2424
Practice Address - Fax:787-724-5104
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-25
Last Update Date:2023-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP0905XAmbulatory Health Care FacilitiesClinic/CenterPublic Health, State or Local
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR27OtherSTATE LICENSE
PR821205OtherMMM
PR100-133OtherCRUZ AZUL
PR660-42-70PSOtherCOSVI
PR400015OtherMEDICARE
PR400805OtherPMC
PR4411-3/5OtherPROSSAM