=====================================================
General NPI Number Information
=====================================================
NPI Number | 1205677937
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HOSPITAL DE LA CONCEPCION INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/05/2024
-----------------------------------------------------
Last Update Date | 06/10/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2 AVE LUIS MUNOZ MARIN
-----------------------------------------------------
City | HORMIGUEROS
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00660-1737
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-892-1860
-----------------------------------------------------
Fax | 787-892-4500
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 285
-----------------------------------------------------
City | SAN GERMAN
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00683-0285
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-892-1860
-----------------------------------------------------
Fax | 787-892-4500
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | ADMINISTRATOR
-----------------------------------------------------
Name | FELICITA BONILLA RIVERA
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 787-892-1860
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QE0002X
-----------------------------------------------------
Taxonomy Name | Emergency Care Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------