Healthcare Provider Details

I. General information

NPI: 1659196004
Provider Name (Legal Business Name): HOSPITAL STL CANUVA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/20/2024
Last Update Date: 11/20/2024
Certification Date: 11/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CALLE FORTIN JIMENEZ MZA. 54 LOT. 12 EL ZACATAL
SAN JOSE DEL CABO BAJA CALIFORNIA SUR
23427
MX

IV. Provider business mailing address

PO BOX 39662
FORT LAUDERDALE FL
33339-9662
US

V. Phone/Fax

Practice location:
  • Phone: 624-247-2911
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License Number
License Number State

VIII. Authorized Official

Name: MARIO TREJO
Title or Position: DIRECTOR
Credential:
Phone: 624-247-2911