Basic Information
| Provider Information | |||||||||
| NPI: | 1760664643 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | METRO HATO REY INC | ||||||||
| LastName: | |||||||||
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| Credential: | |||||||||
| OtherOrganizationName: | HOSPITAL PAVIA HATO REY-BEHAVIOR | ||||||||
| OtherOrganizationType: | 5 | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 190828 | ||||||||
| Address2: | |||||||||
| City: | SAN JUAN | ||||||||
| State: | PR | ||||||||
| PostalCode: | 009190828 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7876412323 | ||||||||
| FaxNumber: | 7877566747 | ||||||||
| Practice Location | |||||||||
| Address1: | AVE. PONCE DE LEON #435 | ||||||||
| Address2: | FLOORS 4TH & 5TH | ||||||||
| City: | HATO REY | ||||||||
| State: | PR | ||||||||
| PostalCode: | 00917 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7876412323 | ||||||||
| FaxNumber: | 7877566747 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/03/2007 | ||||||||
| LastUpdateDate: | 08/18/2008 | ||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | SOLA | ||||||||
| AuthorizedOfficialFirstName: | LAURA | ||||||||
| AuthorizedOfficialMiddleName: | IVETTE | ||||||||
| AuthorizedOfficialTitleorPosition: | FINANCE DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 7876412323 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 273R00000X | 71 | PR | Y | Hospital Units | Psychiatric Unit |
ID Information
| ID | Type | State | Issuer | Description | 40S128 | 01 | PR | MEDICARE | OTHER |