Healthcare Provider Details

I. General information

NPI: 1376353797
Provider Name (Legal Business Name): HOSPITEN VALLARTA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/08/2025
Last Update Date: 01/08/2025
Certification Date: 01/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

BLVD FCO. MEDINA ASCENCIO # 3970 COL. VILLA LAS FLORES
PUERTO VALLARTA JALISCO
48335
MX

IV. Provider business mailing address

PO BOX 39662
FT LAUDERDALE FL
33339-9662
US

V. Phone/Fax

Practice location:
  • Phone: 322-226-2080
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282NC0060X
TaxonomyCritical Access Hospital
License Number
License Number State

VIII. Authorized Official

Name: MARIO DE LA TORRE
Title or Position: MANAGER
Credential:
Phone: 954-526-9751