Basic Information
| Provider Information | |||||||||
| NPI: | 1104856889 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | HOSPITAL SAN CARLOS INCORPORADO | ||||||||
| LastName: | |||||||||
| FirstName: | |||||||||
| MiddleName: | |||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | |||||||||
| OtherOrganizationName: | HOSPITAL SAN CARLOS BORROMEO | ||||||||
| OtherOrganizationType: | 3 | ||||||||
| OtherLastName: | |||||||||
| OtherFirstName: | |||||||||
| OtherMiddleName: | |||||||||
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| OtherCredential: | |||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 68 | ||||||||
| Address2: | |||||||||
| City: | MOCA | ||||||||
| State: | PR | ||||||||
| PostalCode: | 006760068 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7878778000 | ||||||||
| FaxNumber: | 7878775610 | ||||||||
| Practice Location | |||||||||
| Address1: | CARR. 110 BARRIO PUEBLO | ||||||||
| Address2: | CALLE CONCEPCION VERA NUM. 550 S. | ||||||||
| City: | MOCA | ||||||||
| State: | PR | ||||||||
| PostalCode: | 006760068 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7878778000 | ||||||||
| FaxNumber: | 7878775610 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/05/2006 | ||||||||
| LastUpdateDate: | 08/11/2010 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | CRESPO | ||||||||
| AuthorizedOfficialFirstName: | ROSAIDA | ||||||||
| AuthorizedOfficialMiddleName: | M | ||||||||
| AuthorizedOfficialTitleorPosition: | EXECUTIVE DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 7878778000 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | MHSA | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 282NR1301X | 20 | PR | Y | Hospitals | General Acute Care Hospital | Rural |
No ID Information.