Basic Information
| Provider Information | |||||||||
| NPI: | 1720383458 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | HOSPITAL GENERAL MENONITA AIBONITO | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 1184 | ||||||||
| Address2: | |||||||||
| City: | AIBONITO | ||||||||
| State: | PR | ||||||||
| PostalCode: | 007051184 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 1787318500 | ||||||||
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| Practice Location | |||||||||
| Address1: | HOSPITAL GENERAL MENONITA AIBONITO | ||||||||
| Address2: | BO. CAONILLA | ||||||||
| City: | AIBONITO | ||||||||
| State: | PR | ||||||||
| PostalCode: | 00705 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7877358001 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/11/2011 | ||||||||
| LastUpdateDate: | 07/05/2011 | ||||||||
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| AuthorizedOfficialLastName: | MERCADO MATOS | ||||||||
| AuthorizedOfficialFirstName: | MARILIS | ||||||||
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| AuthorizedOfficialTitleorPosition: | DIETITIAN | ||||||||
| AuthorizedOfficialTelephone: | 17877358001 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MS. | ||||||||
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| AuthorizedOfficialCredential: | LND | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QC1500X | 1521 | PR | Y | Ambulatory Health Care Facilities | Clinic/Center | Community Health |
No ID Information.