Healthcare Provider Details

I. General information

NPI: 1265594378
Provider Name (Legal Business Name): HOSPITAL ANDRES GRILLASCA,INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/14/2006
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: 787-840-9732
Mailing address:
  • Phone: 787-848-0800
  • Fax: 787-840-9732

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: MR. ELYONEL PONTON
Title or Position: CHIEF OPERATION OFFICER
Credential: COO
Phone: 787-848-0800