Healthcare Provider Details

I. General information

NPI: 1295991453
Provider Name (Legal Business Name): FIRST HOSPITAL PANAMERICANO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/06/2008
Last Update Date: 08/06/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2213 PONCE BY PASS HOSPTIAL DAMAS 8VO PISO
PONCE PR
00717-1318
US

IV. Provider business mailing address

PO BOX 1400
CIDRA PR
00739-1400
US

V. Phone/Fax

Practice location:
  • Phone: 787-842-0045
  • Fax: 787-259-7536
Mailing address:
  • Phone: 787-739-5555
  • Fax: 787-739-0035

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number97CNCNUM.91173
License Number StatePR

VIII. Authorized Official

Name: MRS. TANIA E CONDE
Title or Position: C.E.O ADMINISTRATOR
Credential:
Phone: 787-739-5555