Healthcare Provider Details

I. General information

NPI: 1114609872
Provider Name (Legal Business Name): HOSPITAL SAN ANTONIO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/02/2023
Last Update Date: 04/09/2024
Certification Date: 04/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CARRETERA ORIENTE HIDALGO NO 23 SAN ANTONIO TLAYACAPAN
AJIJIC JALISCO
45922
MX

IV. Provider business mailing address

5219 MCPHERSON RD STE 430
LAREDO TX
78041-7306
US

V. Phone/Fax

Practice location:
  • Phone: 376-689-0911
  • Fax:
Mailing address:
  • Phone: 619-988-6512
  • 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: MR. JORGE ALBERTO CALDERON PRIETO
Title or Position: DIRECTOR GENERAL
Credential:
Phone: 619-988-6512