Healthcare Provider Details

I. General information

NPI: 1063974988
Provider Name (Legal Business Name): HOSPITAL ESPANOL AUXILIO MUTUO DE PUERTO RICO, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/01/2019
Last Update Date: 04/01/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

715 AVE PONCE DE LEON STOP 37.5
SAN JUAN PR
00917
US

IV. Provider business mailing address

PO BOX 191227
SAN JUAN PR
00919-1227
US

V. Phone/Fax

Practice location:
  • Phone: 787-771-7934
  • Fax: 787-771-7402
Mailing address:
  • Phone: 787-771-7934
  • Fax: 787-771-7402

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. RAFAEL JACA
Title or Position: BUSSINES OFFICE DIRECTOR
Credential:
Phone: 787-771-7934