=====================================================
General NPI Number Information
=====================================================
NPI Number | 1114169679
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | TEMPLE UNIVERSITY HOSPITAL
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/30/2009
-----------------------------------------------------
Last Update Date | 03/30/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 8432 RIDGE AVE
-----------------------------------------------------
City | PHILADELPHIA
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19128-2114
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 215-900-3815
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 8432 RIDGE AVE
-----------------------------------------------------
City | PHILADELPHIA
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19128-2114
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MEDICAL DOCTOR
-----------------------------------------------------
Name | GONZALO LUIZAGA COCA
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 215-900-3815
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 282N00000X
-----------------------------------------------------
Taxonomy Name | General Acute Care Hospital
-----------------------------------------------------
License Number | 189910
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------