Healthcare Provider Details

I. General information

NPI: 1649700535
Provider Name (Legal Business Name): GRUPO HOSPITALISTAS SAN JORGE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/14/2017
Last Update Date: 06/14/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

258 CALLE SAN JORGE
SAN JUAN PR
00912
US

IV. Provider business mailing address

PO BOX 6308
SAN JUAN PR
00914-6308
US

V. Phone/Fax

Practice location:
  • Phone: 787-727-1000
  • Fax:
Mailing address:
  • Phone: 787-283-3476
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number
License Number State

VIII. Authorized Official

Name: MURIEL MARTINEZ
Title or Position: BILLING COMPANY
Credential:
Phone: 787-632-3445