Healthcare Provider Details

I. General information

NPI: 1922337146
Provider Name (Legal Business Name): HOSPICIO SAN MIGUEL, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/17/2009
Last Update Date: 01/26/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PLAZA ALONSO BO. MIRADERO CARR. PR-311 KM 3.2 INTERSECCION CARR. PR-100
CABO ROJO PR
00623
US

IV. Provider business mailing address

PO BOX 688
MAYAGUEZ PR
00681-0688
US

V. Phone/Fax

Practice location:
  • Phone: 787-851-2962
  • Fax: 787-851-2962
Mailing address:
  • Phone: 787-851-2962
  • Fax: 787-851-2962

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code315D00000X
TaxonomyInpatient Hospice
License Number11-B-4687
License Number StatePR

VIII. Authorized Official

Name: MR. HECTOR M. ALONSO
Title or Position: PRESIDENT
Credential:
Phone: 787-692-2457