Healthcare Provider Details

I. General information

NPI: 1669509907
Provider Name (Legal Business Name): HOSPITAL SANTA ROSA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/27/2007
Last Update Date: 11/13/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

LOS VETERANOS AVE ROAD NO 3 SALIDA HACIA ARROYO
GUAYAMA PR
00785
US

IV. Provider business mailing address

PO BOX 10008 SAME
GUAYAMA PR
00785-4008
US

V. Phone/Fax

Practice location:
  • Phone: 787-864-0101
  • Fax:
Mailing address:
  • Phone: 787-864-0101
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0002X
TaxonomyClinic Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: MISS LCDA. GLORIA DIAZ VILA
Title or Position: ADMINISTRATOR
Credential: ADMINISTRATOR
Phone: 17878665007