Healthcare Provider Details

I. General information

NPI: 1811001613
Provider Name (Legal Business Name): SAN JORGE CHILDREN'S HOSPITAL, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/18/2006
Last Update Date: 12/31/2019
Certification Date: 12/31/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

258 CALLE SAN JORGE
SAN JUAN PR
00912-3239
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: 787-268-8702
Mailing address:
  • Phone: 787-727-1000
  • Fax: 787-268-8702

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282NC2000X
TaxonomyChildren's Hospital
License Number64
License Number StatePR

VIII. Authorized Official

Name: MR. JOSE L RODRIGUEZ
Title or Position: VICE PRESIDENT AND EXECUTIVE DIRECT
Credential: MHSA
Phone: 787-727-1000