Healthcare Provider Details

I. General information

NPI: 1881998334
Provider Name (Legal Business Name): BELLA VISTA HOSPITAL, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/27/2010
Last Update Date: 10/02/2024
Certification Date: 10/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

349 ST. KM 3.4
MAYAGUEZ PR
00680
US

IV. Provider business mailing address

PO BOX 1750
MAYAGUEZ PR
00681-1750
US

V. Phone/Fax

Practice location:
  • Phone: 787-834-6000
  • Fax: 787-805-3705
Mailing address:
  • Phone: 787-834-6000
  • Fax: 787-805-3705

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. LUIS RIVERA
Title or Position: DIRECTOR
Credential: MBA
Phone: 787-834-6000