Healthcare Provider Details

I. General information

NPI: 1043329048
Provider Name (Legal Business Name): FUNDACION MANUEL DE LA PILA IGLESIA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/30/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2431 AVE LAS AMERICAS
PONCE PR
00717-2113
US

IV. Provider business mailing address

PO BOX 331910
PONCE PR
00733-1910
US

V. Phone/Fax

Practice location:
  • Phone: 787-848-5600
  • Fax: 787-651-5686
Mailing address:
  • Phone: 787-848-5600
  • Fax: 787-651-5686

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number52
License Number StatePR

VIII. Authorized Official

Name: MR. ROBERTO RENTAS
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 787-848-5600