1477576049 NPI number — HOSPITAL ESPANOL AUXILIO MUTUO DE PUERTO RICO, INC.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1477576049 NPI number — HOSPITAL ESPANOL AUXILIO MUTUO DE PUERTO RICO, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HOSPITAL ESPANOL AUXILIO MUTUO DE PUERTO RICO, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1477576049
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 191227
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAN JUAN
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00919-1227
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-758-2000
Provider Business Mailing Address Fax Number:
787-771-7927

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
735 AVE PONCE DE LEON
Provider Second Line Business Practice Location Address:
STOP 37.5
Provider Business Practice Location Address City Name:
SAN JUAN
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00917-5022
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-758-2000
Provider Business Practice Location Address Fax Number:
787-771-7927
Provider Enumeration Date:
07/25/2006

Additional Information

Authorized Official

Authorized Official Last Name:
MATTA
Authorized Official First Name:
JORGE
Authorized Official Middle Name:
L.
Authorized Official Title or Position:
ADMINISTRATOR
Authorized Official Telephone Number:
787-758-2000

Provider Taxonomy Codes

  • Taxonomy code: 282N00000X , registered in the state of PR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 30711 . This is a "LAB CARDIOVASCULAR" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".




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