Basic Information
Provider Information
NPI: 1811001613
EntityType: 2
ReplacementNPI:  
OrganizationName: SAN JORGE CHILDREN'S HOSPITAL, INC.
LastName:  
FirstName:  
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential:  
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
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OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: PO BOX 6308
Address2:  
City: SAN JUAN
State: PR
PostalCode: 009146308
CountryCode: US
TelephoneNumber: 7877271000
FaxNumber: 7872688702
Practice Location
Address1: 258 CALLE SAN JORGE
Address2:  
City: SAN JUAN
State: PR
PostalCode: 009123239
CountryCode: US
TelephoneNumber: 7877271000
FaxNumber: 7872688702
Other Information
ProviderEnumerationDate: 08/18/2006
LastUpdateDate: 12/31/2019
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode:  
AuthorizedOfficialLastName: RODRIGUEZ
AuthorizedOfficialFirstName: JOSE
AuthorizedOfficialMiddleName: L
AuthorizedOfficialTitleorPosition: VICE PRESIDENT AND EXECUTIVE DIRECT
AuthorizedOfficialTelephone: 7877271000
IsSoleProprietor:  
IsOrganizationSubpart: N
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix: MR.
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential: MHSA
NPICertificationDate: 12/31/2019

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
282NC2000X64PRY HospitalsGeneral Acute Care HospitalChildren

No ID Information.


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