=====================================================
General NPI Number Information
=====================================================
NPI Number | 1184388738
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CMQ HOSPITALS
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/28/2021
-----------------------------------------------------
Last Update Date | 10/28/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | HOSPITAL CMQ AV. FRANCISCO VILLA 1749 VALLARTA VILLAS
-----------------------------------------------------
City | PUERTO VALLARTA
-----------------------------------------------------
State | JALISCO
-----------------------------------------------------
Zip | 48300
-----------------------------------------------------
Country | MX
-----------------------------------------------------
Telephone | 322-226-6500
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | HOSPITAL CMQ 1400 VILLAGE SQUARE BLVD #3-80638
-----------------------------------------------------
City | TALLAHASSEE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32312
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. JORGE ALEX VILLANUEVA
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 322-226-6500
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QU0200X
-----------------------------------------------------
Taxonomy Name | Urgent Care Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------