MEDICARE: SAN JORGE CHILDREN'S 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	282NC2000X	Children's Hospital	64	PR

General Provider Information

NPI Number	:	1811001613
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SAN JORGE CHILDREN'S HOSPITAL, INC.

Provider Business Mailing Address
First Line	:	PO BOX 6308
Second Line	:
City	:	SAN JUAN
State	:	PR
Zip	:	00914-6308
Country	:	US
Telephone Number	:	787-727-1000
Fax Number	:	787-268-8702

Provider Business Practice Location Address
First Line	:	258 CALLE SAN JORGE
Second Line	:
City	:	SAN JUAN
State	:	PR
Zip	:	00912-3239
Country	:	US
Telephone Number	:	787-727-1000
Fax Number	:	787-268-8702

Authorized Official
Title or Position	:	VICE PRESIDENT AND EXECUTIVE DIRECT
Name	:	MR. JOSE L RODRIGUEZ
Credential	:	MHSA
Telephone Number	:	787-727-1000

Provider Enumeration Date	:	08/18/2006
Last Update Date	:	12/31/2019

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Practice Location Address:

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Practice Location Address:

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