Healthcare Provider Details

I. General information

NPI: 1851511174
Provider Name (Legal Business Name): HOSPITAL ANDRES GRILLASCA, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/27/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

TITO CASTRO AVE.CARR.14 BO. MACHUELO
PONCE PR
00733-1324
US

IV. Provider business mailing address

PO BOX 331324
PONCE PR
00733-1324
US

V. Phone/Fax

Practice location:
  • Phone: 787-848-0800
  • Fax: 787-843-2310
Mailing address:
  • Phone: 787-848-0800
  • Fax: 787-843-2310

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number21
License Number StatePR

VIII. Authorized Official

Name: MR. MANUEL J. VAZQUEZ
Title or Position: ADMINISTRATOR
Credential:
Phone: 787-848-0800