Healthcare Provider Details

I. General information

NPI: 1285648006
Provider Name (Legal Business Name): HOSPITAL ESPANOL AUXILIO MUTUO DEPUERTO RICO, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/28/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

735 AVE PONCE DE LEON STOP 37.5
SAN JUAN PR
00917-5022
US

IV. Provider business mailing address

PO BOX 191227
SAN JUAN PR
00919-1227
US

V. Phone/Fax

Practice location:
  • Phone: 787-758-2000
  • Fax: 787-771-7927
Mailing address:
  • Phone: 787-758-2000
  • Fax: 787-771-7975

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License Number
License Number StatePR

VIII. Authorized Official

Name: MR. JORGE L. MATTA
Title or Position: ADMINISTRATOR
Credential: MHSA
Phone: 787-758-2000