Healthcare Provider Details

I. General information

NPI: 1093843278
Provider Name (Legal Business Name): COMERIO MEDICAL HOSPITAL, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/01/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

STREET 778 KM 0.9
COMERIO PR
00782-1103
US

IV. Provider business mailing address

PO BOX 1103 BO. PASARELL
COMERIO PR
00782-1103
US

V. Phone/Fax

Practice location:
  • Phone: 787-875-3136
  • Fax: 787-875-1434
Mailing address:
  • Phone: 787-875-3136
  • Fax: 787-875-1434

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number07-F-2139
License Number StatePR

VIII. Authorized Official

Name: LUIS MANUEL GONZALEZ
Title or Position: PRESIDENTE
Credential: M.D.
Phone: 787-875-3136