Provider Information for 1710221262
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SAN JUAN DE DIOS LLC
Organization Subpart: NO
NPI: 1710221262
Last Updated: 2012-11-30
Certification Date:
Certification Date:
Details
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NPI | 1710221262 | ||||||||
Enumeration Date | 2012-11-22 | ||||||||
NPI Type | NPI-2 Organization | ||||||||
Status | Active | ||||||||
Authorized Official Information | Name: NEETA TRIPATHI Title: PRESIDENT Phone: 2672063861 | ||||||||
Mailing Address | 2122 GALLOWAY RD BENSALEM, PA 19020-2988 United States Phone: 267-206-3861 | Fax: | ||||||||
Primary Practice Address | 961 N 10TH ST READING, PA 19604-2353 United States Phone: 610-743-4501 | Fax: | ||||||||
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