=====================================================
General NPI Number Information
=====================================================
NPI Number | 1326835703
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MAYAGUEZ MEDICAL CENTER - SAN ANTONIO INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/21/2025
-----------------------------------------------------
Last Update Date | 04/21/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 18 NORTE CALLE DR RAMON EMETERIO BETANCES
-----------------------------------------------------
City | MAYAGUEZ
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00681
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-652-9200
-----------------------------------------------------
Fax | 787-652-9222
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 600
-----------------------------------------------------
City | MAYAGUEZ
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00681-0600
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-652-9200
-----------------------------------------------------
Fax | 787-652-9222
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | MR. JAIME F MAESTRE
-----------------------------------------------------
Credential | MHSA
-----------------------------------------------------
Telephone | 787-652-9200
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 282N00000X
-----------------------------------------------------
Taxonomy Name | General Acute Care Hospital
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------