Healthcare Provider Details

I. General information

NPI: 1588693022
Provider Name (Legal Business Name): HOSPITAL DAMAS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/30/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2213 PONCE BY PASS
PONCE PR
00717-1318
US

IV. Provider business mailing address

286 CALLE MONTERREY
PONCE PR
00716-0377
US

V. Phone/Fax

Practice location:
  • Phone: 878-840-8686
  • Fax: 787-259-7364
Mailing address:
  • Phone: 787-840-8686
  • Fax: 787-259-7364

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332BP3500X
TaxonomyParenteral & Enteral Nutrition Supplies (DME)
License Number
License Number StatePR

VIII. Authorized Official

Name: MR. ENRIQUE A VICENS JR.
Title or Position: ADMINISTRADOR & COO
Credential: MHSA
Phone: 787-840-2395