Basic Information
| Provider Information | |||||||||
| NPI: | 1972818599 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | HOSPITAL EPISCOPAL SAN LUCAS PONCE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 26 CALLE MUNOZ RIVERA | ||||||||
| Address2: | |||||||||
| City: | ADJUNTAS | ||||||||
| State: | PR | ||||||||
| PostalCode: | 006012201 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7874147782 | ||||||||
| FaxNumber: | 7878441271 | ||||||||
| Practice Location | |||||||||
| Address1: | 917 AVE TITO CASTRO | ||||||||
| Address2: | |||||||||
| City: | PONCE | ||||||||
| State: | PR | ||||||||
| PostalCode: | 007164717 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7878442080 | ||||||||
| FaxNumber: | 7878441271 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/09/2010 | ||||||||
| LastUpdateDate: | 08/09/2010 | ||||||||
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| AuthorizedOfficialLastName: | VAZQUEZ-TORRES | ||||||||
| AuthorizedOfficialFirstName: | ORLANDO | ||||||||
| AuthorizedOfficialMiddleName: | LUIS | ||||||||
| AuthorizedOfficialTitleorPosition: | PROGRAM DIRECTOR INTERNAL MEDICINE | ||||||||
| AuthorizedOfficialTelephone: | 7878442080 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | M.D, FCCP,FACP | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 282N00000X | 28134 | PR | Y | Hospitals | General Acute Care Hospital |
No ID Information.