Healthcare Provider Details

I. General information

NPI: 1639321102
Provider Name (Legal Business Name): OUR LADY OF PURIFICACION DOCTORS HOSPITAL,INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/16/2008
Last Update Date: 10/16/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

SUITE 410, MT. CREST HOTEL LEGARDA ROAD, BAGUIO CITY
BAGUIO BENGUET
26000
PH

IV. Provider business mailing address

SUITE 410, MT. CREST HOTEL LEGARDA ROAD, BAGUIO CITY
BAGUIO BENGUET
26000
PH

V. Phone/Fax

Practice location:
  • Phone: 630744457001
  • Fax:
Mailing address:
  • Phone: 630744457001
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282E00000X
TaxonomyLong Term Care Hospital
License Number04251966
License Number StateZZ

VIII. Authorized Official

Name: DR. FAITH AMORFINA T SUBIDO
Title or Position: DOCTOR
Credential:
Phone: 630744457001