Organization
PROGRAMA SIDA DE SAN JUAN
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. AMAURY LLUVERAS LIC (ADMINISTRATOR)
(787) 480-3000
Entity
Organization
Contact information
Practice address
1306 AVE FERNANDEZ JUNCOS, SAN JUAN, PR 00909-2521
(787) 723-2424
(787) 724-5104
Mailing address
PO BOX 21405, SAN JUAN, PR 00928-1405
(787) 480-3000
(787) 724-5104
Taxonomy
Speciality
Code
Description
License number
State
261QP0905X
State or Local Public Health Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
100-133
CRUZ AZUL
PR
01
—
27
STATE LICENSE
PR
01
—
400015
MEDICARE
PR
01
—
400805
PMC
PR
01
—
4411-3/5
PROSSAM
PR
01
—
660-42-70PS
COSVI
PR
01
—
821205
MMM
PR
Enumeration date
05/25/2007
Last updated
05/16/2023
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