Healthcare Provider Details

I. General information

NPI: 1881095339
Provider Name (Legal Business Name): BELLA VISTA HOSPITAL INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/15/2014
Last Update Date: 09/15/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

349 ST. KM 3.4
MAYAGUEZ PR
00680-0000
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 TaxonomyY
Taxonomy Code2081S0010X
TaxonomySports Medicine (Physical Medicine & Rehabilitation) Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. JOSE GUILLERMO GRATACOS
Title or Position: CHIEF FINANCIAL OFFICER
Credential: CFO
Phone: 787-834-2350