Healthcare Provider Details

I. General information

NPI: 1770697757
Provider Name (Legal Business Name): RYDER MEMORIAL HOSPITAL INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/18/2006
Last Update Date: 11/12/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

355 AVE FONT MARTELO BOX 859
HUMACAO PR
00791-3249
US

IV. Provider business mailing address

PO BOX 859
HUMACAO PR
00792-0859
US

V. Phone/Fax

Practice location:
  • Phone: 787-852-0768
  • Fax: 787-850-1444
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3336C0002X
TaxonomyClinic Pharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number07F0947
License Number StatePR

VIII. Authorized Official

Name: JOSE SEPULVEDA
Title or Position: CEO
Credential:
Phone: 787-852-0768