Basic Information
| Provider Information | |||||||||
| NPI: | 1639316995 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | CENTRO CIRUGIA AMBULATORIA HOSPITAL SAN ANTONIO | ||||||||
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| Mailing Information | |||||||||
| Address1: | P O BOX 546 | ||||||||
| Address2: | |||||||||
| City: | MAYAGUEZ | ||||||||
| State: | PR | ||||||||
| PostalCode: | 006810546 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7878340050 | ||||||||
| FaxNumber: | 7878342104 | ||||||||
| Practice Location | |||||||||
| Address1: | RAMON EMETERIO BETANCES 18 NORTE | ||||||||
| Address2: | |||||||||
| City: | MAYAGUEZ | ||||||||
| State: | PR | ||||||||
| PostalCode: | 006810546 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7878340050 | ||||||||
| FaxNumber: | 7878342104 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/08/2009 | ||||||||
| LastUpdateDate: | 01/08/2009 | ||||||||
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| AuthorizedOfficialLastName: | ROY | ||||||||
| AuthorizedOfficialFirstName: | LINDA | ||||||||
| AuthorizedOfficialMiddleName: | K | ||||||||
| AuthorizedOfficialTitleorPosition: | BILLING DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 7878061118 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QA1903X | 29 | PR | Y | Ambulatory Health Care Facilities | Clinic/Center | Ambulatory Surgical |
No ID Information.