Basic Information
| Provider Information | |||||||||
| NPI: | 1932553617 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | PRESBYTERIAN COMMUNITY HOSPITAL INC. | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | PRESBYTERIAN COMMUNITY HOSPITAL INC. | ||||||||
| OtherOrganizationType: | 4 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1451 AVE ASHFORD | ||||||||
| Address2: | |||||||||
| City: | SAN JUAN | ||||||||
| State: | PR | ||||||||
| PostalCode: | 009071511 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7877212160 | ||||||||
| FaxNumber: | 7877254645 | ||||||||
| Practice Location | |||||||||
| Address1: | 1451 AVE ASHFORD | ||||||||
| Address2: | |||||||||
| City: | SAN JUAN | ||||||||
| State: | PR | ||||||||
| PostalCode: | 009071511 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7877212160 | ||||||||
| FaxNumber: | 7877254645 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/19/2016 | ||||||||
| LastUpdateDate: | 04/19/2016 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | TORRES | ||||||||
| AuthorizedOfficialFirstName: | MAYRA | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | CFO | ||||||||
| AuthorizedOfficialTelephone: | 7877212160 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | CPA | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 291U00000X | 96 | PR | Y | Laboratories | Clinical Medical Laboratory |
No ID Information.