Basic Information
| Provider Information | |||||||||
| NPI: | 1992369615 | ||||||||
| 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: | 7877582000 | ||||||||
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| Practice Location | |||||||||
| Address1: | 715 AVE PONCE DE LEON | ||||||||
| Address2: | |||||||||
| City: | SAN JUAN | ||||||||
| State: | PR | ||||||||
| PostalCode: | 009175032 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7877582000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/29/2019 | ||||||||
| LastUpdateDate: | 04/29/2019 | ||||||||
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| AuthorizedOfficialLastName: | JACA | ||||||||
| AuthorizedOfficialFirstName: | RAFAEL | ||||||||
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| AuthorizedOfficialTitleorPosition: | BUSSINES OFFICE DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 7877717934 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | HOSPITAL ESPANOL AUXILIO MUTUO DE PUERTO RICO, INC. | ||||||||
| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QR0400X | Y | Ambulatory Health Care Facilities | Clinic/Center | Rehabilitation |
No ID Information.