Basic Information
| Provider Information | |||||||||
| NPI: | 1114275815 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | MUNICIPALITY OF SAN JUAN PR DIRECTOR DE FINANZAS | ||||||||
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| Mailing Information | |||||||||
| Address1: | SAN JUAN CITY HOSPITAL PMB 79 | ||||||||
| Address2: | PO BOX 70344 | ||||||||
| City: | SAN JUAN | ||||||||
| State: | PR | ||||||||
| PostalCode: | 009288344 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7877568535 | ||||||||
| FaxNumber: | 7877643643 | ||||||||
| Practice Location | |||||||||
| Address1: | CENTRO MEDICO | ||||||||
| Address2: | BO. MONACILLOS | ||||||||
| City: | SAN JUAN | ||||||||
| State: | PR | ||||||||
| PostalCode: | 00936 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7877568535 | ||||||||
| FaxNumber: | 7877643643 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/28/2012 | ||||||||
| LastUpdateDate: | 12/13/2012 | ||||||||
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| AuthorizedOfficialLastName: | BOISSEN | ||||||||
| AuthorizedOfficialFirstName: | MYRNA | ||||||||
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| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 7877568535 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MS. | ||||||||
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| AuthorizedOfficialCredential: | M.H.S.A. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 133N00000X | 938 | PR | N | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Dietary & Nutritional Service Providers | Nutritionist | 133N00000X | 1112 | PR | N | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Dietary & Nutritional Service Providers | Nutritionist | 133N00000X | 1225 | PR | N | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Dietary & Nutritional Service Providers | Nutritionist | 133N00000X | 1008 | PR | N | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Dietary & Nutritional Service Providers | Nutritionist | 133N00000X | 432 | PR | N | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Dietary & Nutritional Service Providers | Nutritionist | 133N00000X | 1196 | PR | N | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Dietary & Nutritional Service Providers | Nutritionist | 282N00000X | 30 | PR | Y | Hospitals | General Acute Care Hospital |
No ID Information.