Basic Information
| Provider Information | |||||||||
| NPI: | 1114143187 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | FARMACIA HOSPITAL MENONITA | ||||||||
| LastName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 1379 | ||||||||
| Address2: | |||||||||
| City: | AIBONITO | ||||||||
| State: | PR | ||||||||
| PostalCode: | 007051379 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7877358001 | ||||||||
| FaxNumber: | 7877350384 | ||||||||
| Practice Location | |||||||||
| Address1: | CALLE JOSE C VAZQUEZ | ||||||||
| Address2: | ESQ DR. TROYER | ||||||||
| City: | AIBONITO | ||||||||
| State: | PR | ||||||||
| PostalCode: | 00705 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7877358001 | ||||||||
| FaxNumber: | 7877350384 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/18/2007 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | NORAT | ||||||||
| AuthorizedOfficialFirstName: | RUBEN | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | ADMINISTRATOR | ||||||||
| AuthorizedOfficialTelephone: | 7877358001 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | LCDO. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 282N00000X | 09-F-0513 | PR | Y | Hospitals | General Acute Care Hospital |
No ID Information.