Healthcare Provider Details

I. General information

NPI: 1447594437
Provider Name (Legal Business Name): HOSPITAL EPISCOPAL SAN LUCAS-PONCE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/15/2012
Last Update Date: 11/15/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

917 AVE TITO CASTRO
PONCE PR
00716-4717
US

IV. Provider business mailing address

917 AVE TITO CASTRO
PONCE PR
00716-4717
US

V. Phone/Fax

Practice location:
  • Phone: 787-844-2080
  • Fax:
Mailing address:
  • Phone: 787-844-2080
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code284300000X
TaxonomySpecial Hospital
License Number28992-R
License Number StatePR

VIII. Authorized Official

Name: DR. CARLOS ALBERTO RODRIGUEZ
Title or Position: OB/GYN RESIDENTE
Credential: M.D
Phone: 786-326-4558