Healthcare Provider Details

I. General information

NPI: 1932335734
Provider Name (Legal Business Name): CIRUGIA AMBULATORIA PROFESSIONAL HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/08/2009
Last Update Date: 06/08/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

STREET # 2 NO 46
MANATI PR
00674-0000
US

IV. Provider business mailing address

PO BOX 2698
BAYAMON PR
00960-2698
US

V. Phone/Fax

Practice location:
  • Phone: 787-884-0505
  • Fax: 787-884-0510
Mailing address:
  • Phone: 787-884-0505
  • Fax: 787-884-0510

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number10B1334
License Number StatePR

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier10B1334
Identifier TypeOTHER
Identifier StatePR
Identifier IssuerDEPARTMENT OF HEALTH OF PR

VIII. Authorized Official

Name: DR. LEONARDO IVAN VALENTIN
Title or Position: PRESIDENT BOARD OF DIRECTOR
Credential: MD
Phone: 787-884-0505