Healthcare Provider Details

I. General information

NPI: 1639316995
Provider Name (Legal Business Name): CENTRO CIRUGIA AMBULATORIA HOSPITAL SAN ANTONIO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/08/2009
Last Update Date: 01/08/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

RAMON EMETERIO BETANCES 18 NORTE
MAYAGUEZ PR
00681-0546
US

IV. Provider business mailing address

P O BOX 546
MAYAGUEZ PR
00681-0546
US

V. Phone/Fax

Practice location:
  • Phone: 787-834-0050
  • Fax: 787-834-2104
Mailing address:
  • Phone: 787-834-0050
  • Fax: 787-834-2104

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number29
License Number StatePR

VIII. Authorized Official

Name: MRS. LINDA K ROY
Title or Position: BILLING DIRECTOR
Credential:
Phone: 787-806-1118