| San Juan Primary Health Care Providers, Llc | |
|
Carretera 844 Km 4.2 Bo. Cupey Bajo San Juan PR 00926 | |
| (787) 760-0770 | |
| Not Available |
| Full Name | San Juan Primary Health Care Providers, Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | Carretera 844 Km 4.2 Bo. Cupey Bajo, San Juan, Puerto Rico |
| Authorized Official Name and Position | Santiago Eli Medina-mangual (OWNER) |
| Authorized Official Contact | 7877600770 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| San Juan Primary Health Care Providers, Llc Le 93 Via Paris L'antigua Trujillo Alto PR 00976 Ph: (787) 760-0770 | San Juan Primary Health Care Providers, Llc Carretera 844 Km 4.2 Bo. Cupey Bajo San Juan PR 00926 Ph: (787) 760-0770 |
| NPI Number | 1235411711 |
|---|---|
| Provider Enumeration Date | 09/12/2011 |
| Last Update Date | 02/04/2016 |
| Medicare PECOS PAC ID | 1557665767 |
|---|---|
| Medicare Enrollment ID | O20160209001801 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1235411711 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 208D00000X | General Practice | (* (Not Available)) | Secondary |
| 261QP2300X | Clinic/center - Primary Care | (* (Not Available)) | Primary |
| Provider Name | Santiago E Medina |
|---|---|
| Provider Type | Practitioner - General Practice |
| Provider Identifiers | NPI Number: 1881845782 PECOS PAC ID: 6305907429 Enrollment ID: I20081209000011 |
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