MEDICARE: PROFESSIONAL HOSPITAL GUAYNABO INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2085R0202X	Diagnostic Radiology Physician

General Provider Information

NPI Number	:	1699273029
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PROFESSIONAL HOSPITAL GUAYNABO INC

Provider Business Mailing Address
First Line	:	PO BOX 8973
Second Line	:
City	:	BAYAMON
State	:	PR
Zip	:	00960-8973
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	8 AVE LAS CUMBRES
Second Line	:
City	:	GUAYNABO
State	:	PR
Zip	:	00969-4818
Country	:	US
Telephone Number	:	787-740-8787
Fax Number	:

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	MARIA TERESA MEJIAS
Credential	:
Telephone Number	:	787-740-8787

Provider Enumeration Date	:	01/31/2018
Last Update Date	:	01/31/2018

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