Healthcare Provider Details

I. General information

NPI: 1356561393
Provider Name (Legal Business Name): HOSPITAL ESPANOL AUXILIO MUTUO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/01/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

715 AVE PONCE DE LEON
HATO REY PR
00917-5032
US

IV. Provider business mailing address

715 AVE PONCE DE LEON
HATO REY PR
00917-5032
US

V. Phone/Fax

Practice location:
  • Phone: 787-758-2000
  • Fax: 787-771-7884
Mailing address:
  • Phone: 787-758-2000
  • Fax: 787-771-7884

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0002X
TaxonomyClinic Pharmacy
License Number07F0327
License Number StatePR

VIII. Authorized Official

Name: ILIA MELENDEZ
Title or Position: MANAGER
Credential: RPH
Phone: 787-758-2000