Healthcare Provider Details

I. General information

NPI: 1104064351
Provider Name (Legal Business Name): BELLA VISTA HOSPITAL, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/27/2009
Last Update Date: 10/04/2024
Certification Date: 10/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CARR 349 KM 2.7 CERRO LAS MESAS
MAYAGUEZ PR
00681-8321
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 Code261QX0203X
TaxonomyRadiation Oncology Clinic/Center
License Number000-008
License Number StatePR

VIII. Authorized Official

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