Provider Demographics
NPI:1871623108
Name:CLINICAS EXTERNA CENTRO ACADEMICO SAN JUAN BAUTISTA,INC
Entity type:Organization
Organization Name:CLINICAS EXTERNA CENTRO ACADEMICO SAN JUAN BAUTISTA,INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:YOCASTA
Authorized Official - Middle Name:
Authorized Official - Last Name:BRUGAL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:1787-743-3038
Mailing Address - Street 1:SALIDA 21 CARRETERA 172
Mailing Address - Street 2:P.O. BOX 4968
Mailing Address - City:CAGUAS
Mailing Address - State:PR
Mailing Address - Zip Code:00725-4968
Mailing Address - Country:US
Mailing Address - Phone:178-774-3303
Mailing Address - Fax:787-746-3093
Practice Address - Street 1:SALIDA 21 CARRETERA 172
Practice Address - Street 2:TURABO GARDEN
Practice Address - City:CAGUAS
Practice Address - State:PR
Practice Address - Zip Code:00725-4968
Practice Address - Country:US
Practice Address - Phone:178-774-3303
Practice Address - Fax:787-746-3093
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service