Basic Information
| Provider Information | |||||||||
| NPI: | 1841393345 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | HOSPITAL MENONITA | ||||||||
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| Mailing Information | |||||||||
| Address1: | BO RINCON INTERIOS | ||||||||
| Address2: | BOX 373130 | ||||||||
| City: | CAYEY | ||||||||
| State: | PR | ||||||||
| PostalCode: | 00737 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7875351001 | ||||||||
| FaxNumber: | 7875351021 | ||||||||
| Practice Location | |||||||||
| Address1: | BO RINCON INTERIOR | ||||||||
| Address2: | BOX 73130 | ||||||||
| City: | CAYEY | ||||||||
| State: | PR | ||||||||
| PostalCode: | 00737 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7875351001 | ||||||||
| FaxNumber: | 7875351021 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/07/2006 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | COLON | ||||||||
| AuthorizedOfficialFirstName: | JULIO | ||||||||
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| AuthorizedOfficialTitleorPosition: | FINANCIAL DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 7875351001 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 146D00000X | PR | Y | 193200000X MULTI-SPECIALTY GROUP | Emergency Medical Service Providers | Personal Emergency Response Attendant |
No ID Information.