Healthcare Provider Details

I. General information

NPI: 1174338792
Provider Name (Legal Business Name): UTUADO HEALTH HOSPITAL CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/11/2025
Last Update Date: 02/11/2025
Certification Date: 02/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 CALLE DR ISAAC GONZALEZ
UTUADO PR
00641-2635
US

IV. Provider business mailing address

59 CALLE B
CAMUY PR
00627-2343
US

V. Phone/Fax

Practice location:
  • Phone: 787-896-8383
  • Fax:
Mailing address:
  • Phone: 787-484-8273
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QR0200X
TaxonomyRadiology Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code261QE0002X
TaxonomyEmergency Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JIMMY OLIVERA
Title or Position: ADMINISTRADOR
Credential: MBA, CHP, CHA, CMA
Phone: 787-484-8273