Healthcare Provider Details

I. General information

NPI: 1407148976
Provider Name (Legal Business Name): HOSPITAL ISAAC GONZALEZ MARTINEZ
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/03/2011
Last Update Date: 05/03/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

BARRIO MONACILLO SECTOR CENTRO MEDICO
RIO PIEDRAS PR
00935
US

IV. Provider business mailing address

PO BOX 191811
SAN JUAN PR
00919-1811
US

V. Phone/Fax

Practice location:
  • Phone: 787-763-4149
  • Fax:
Mailing address:
  • Phone: 787-763-4149
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code284300000X
TaxonomySpecial Hospital
License Number65
License Number StatePR

VIII. Authorized Official

Name: MRS. ILIA GARCIA
Title or Position: PRESIDENT BORD OF DIRECTORS
Credential:
Phone: 787-763-4149