Provider Demographics
NPI:1053282251
Name:SSJ300 LLC
Entity type:Organization
Organization Name:SSJ300 LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RAFAEL
Authorized Official - Middle Name:ALEJANDRO
Authorized Official - Last Name:COUTO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-671-0416
Mailing Address - Street 1:373 CALLE SAN JORGE, SUITE 100
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00912-3312
Mailing Address - Country:US
Mailing Address - Phone:787-422-0004
Mailing Address - Fax:
Practice Address - Street 1:373 CALLE SAN JORGE, SUITE 100
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00912-3312
Practice Address - Country:US
Practice Address - Phone:787-422-0004
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-09-12
Last Update Date:2025-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical