MEDICARE: BELLA VISTA HOSPITAL, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RH0003X	Hematology & Oncology Physician
2	261QM2500X	Medical Specialty Clinic/Center

General Provider Information

NPI Number	:	1053837278
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BELLA VISTA HOSPITAL, INC.

Provider Business Mailing Address
First Line	:	PO BOX 424
Second Line	:
City	:	MAYAGUEZ
State	:	PR
Zip	:	00681-0424
Country	:	US
Telephone Number	:	787-834-2350
Fax Number	:	787-805-3580

Provider Business Practice Location Address
First Line	:	CARR 349 KM 2.7
Second Line	:	CERRO LAS MESAS
City	:	MAYAGUEZ
State	:	PR
Zip	:	00680-8321
Country	:	US
Telephone Number	:	787-834-6000
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR
Name	:	MR. LUIS RIVERA
Credential	:
Telephone Number	:	787-834-6000

Provider Enumeration Date	:	08/18/2017
Last Update Date	:	10/04/2024

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1083636179 — BELLA VISTA HOSPITAL INC
Practice Location Address:

CARR 349 KM 2.7 , CERRO LAS MESAS
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00680-8321

Practice Phone: 787-834-6000
Practice Fax: 787-805-3705

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00680-8321

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1952817645 — DR. JOSE R MEDRANO PEREZ III MD
Practice Location Address:

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00680-8321

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1053016998 — JARITZA RODRIGUEZ DIAZ MD
Practice Location Address:

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00680-8321

Practice Phone: 787-834-6000
Practice Fax:

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