MEDICARE: HOSPITAL ESPANOL AUXILIO MUTUO DE PUERTO RICO, 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	174400000X	Specialist	41	PR

General Provider Information

NPI Number	:	1487947214
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HOSPITAL ESPANOL AUXILIO MUTUO DE PUERTO RICO, INC.

Provider Business Mailing Address
First Line	:	PO BOX 191227
Second Line	:
City	:	SAN JUAN
State	:	PR
Zip	:	00919-1227
Country	:	US
Telephone Number	:	787-771-7934
Fax Number	:	787-771-7402

Provider Business Practice Location Address
First Line	:	735 AVE PONCE DE LEON STE 375
Second Line	:
City	:	SAN JUAN
State	:	PR
Zip	:	00917-5025
Country	:	US
Telephone Number	:	787-771-7934
Fax Number	:	787-771-7402

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	MR. JORGE LUIS MATTA
Credential	:	MHSA
Telephone Number	:	787-758-2000

Provider Enumeration Date	:	05/26/2011
Last Update Date	:	12/05/2023

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