Healthcare Provider Details

I. General information

NPI: 1548803554
Provider Name (Legal Business Name): HOSPITAL MEXICO DE BC SA DE CV
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/22/2019
Last Update Date: 10/22/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PASEO TIJUANA NO. 9077 COL. EMPLEADOS
TIJUANA BAJA CALIFORNIA
22010
MX

IV. Provider business mailing address

PO BOX 2508
CHULA VISTA CA
91912-2508
US

V. Phone/Fax

Practice location:
  • Phone: 619-482-8608
  • Fax: 619-421-4303
Mailing address:
  • Phone: 619-482-8608
  • Fax: 619-421-4303

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License Number
License Number State

VIII. Authorized Official

Name: MANUEL RAFAEL LAZO
Title or Position: OWNER
Credential:
Phone: 619-482-8608