Healthcare Provider Details

I. General information

NPI: 1629099338
Provider Name (Legal Business Name): COMERIO MEDICAL HOSPITAL INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/21/2006
Last Update Date: 05/23/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CARR 778 KM 0.9 BO PASARELL
COMERIO PR
00782-1103
US

IV. Provider business mailing address

PO BOX 1103
COMERIO PR
00782-1103
US

V. Phone/Fax

Practice location:
  • Phone: 787-875-3136
  • Fax: 787-875-4904
Mailing address:
  • Phone: 787-875-3136
  • Fax: 787-875-4904

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QE0002X
TaxonomyEmergency Care Clinic/Center
License Number07B2934
License Number StatePR
# 2
Primary TaxonomyN
Taxonomy Code261QR0200X
TaxonomyRadiology Clinic/Center
License Number07B2934
License Number StatePR
# 3
Primary TaxonomyN
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number1062
License Number StatePR

VIII. Authorized Official

Name: DR. LUIS M GONZALEZ BERMUDEZ
Title or Position: PRESIDENT
Credential: MD
Phone: 787-316-1212