Basic Information
| Provider Information | |||||||||
| NPI: | 1952721433 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | HOSPITAL ESPANOL AUXILIO MUTUO DE PUERTO RICO, INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 191227 | ||||||||
| Address2: | |||||||||
| City: | SAN JUAN | ||||||||
| State: | PR | ||||||||
| PostalCode: | 009191227 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7877717934 | ||||||||
| FaxNumber: | 7877717402 | ||||||||
| Practice Location | |||||||||
| Address1: | 735 AVE PONCE DE LEON STE 375 | ||||||||
| Address2: | |||||||||
| City: | SAN JUAN | ||||||||
| State: | PR | ||||||||
| PostalCode: | 009175025 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7877717934 | ||||||||
| FaxNumber: | 7877717402 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/23/2014 | ||||||||
| LastUpdateDate: | 01/26/2015 | ||||||||
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| AuthorizedOfficialLastName: | MATTA | ||||||||
| AuthorizedOfficialFirstName: | JORGE | ||||||||
| AuthorizedOfficialMiddleName: | LUIS | ||||||||
| AuthorizedOfficialTitleorPosition: | ADMINISTRATOR | ||||||||
| AuthorizedOfficialTelephone: | 17877582000 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | GRUPO MULTIESPECIALISTAS HAM | ||||||||
| AuthorizedOfficialNamePrefix: | MR. | ||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | MHSA | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X | 41 | PR | Y | 193200000X MULTI-SPECIALTY GROUP | Other Service Providers | Specialist |
No ID Information.