Healthcare Provider Details

I. General information

NPI: 1639696289
Provider Name (Legal Business Name): HOSPITAL MENONITA GUAYAMA INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/24/2017
Last Update Date: 06/16/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

URB. LA HACIENDA ALBIZU CAMPOS ESQUINA PRINCIPAL
GUAYAMA PR
00784-0011
US

IV. Provider business mailing address

PO BOX 1650
CIDRA PR
00739-1650
US

V. Phone/Fax

Practice location:
  • Phone: 787-434-1700
  • Fax: 787-434-1714
Mailing address:
  • Phone: 787-434-1700
  • Fax: 787-434-1714

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282NC0060X
TaxonomyCritical Access Hospital
License Number17-086
License Number StatePR

VIII. Authorized Official

Name: LISSETTE VAZQUEZ RIVERA
Title or Position: BILLING AND CODING MANAGER
Credential:
Phone: 787-434-1700