Provider Demographics
NPI:1043592553
Name:BELLA VISTA HOSPITAL, INC
Entity Type:Organization
Organization Name:BELLA VISTA HOSPITAL, INC
Other - Org Name:PEDIATRAS DEL OESTE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:ENRIQUE
Authorized Official - Middle Name:
Authorized Official - Last Name:RIVERA
Authorized Official - Suffix:
Authorized Official - Credentials:MBA
Authorized Official - Phone:787-652-6031
Mailing Address - Street 1:PO BOX 1750
Mailing Address - Street 2:
Mailing Address - City:MAYAGUEZ
Mailing Address - State:PR
Mailing Address - Zip Code:00681-1750
Mailing Address - Country:US
Mailing Address - Phone:787-652-6031
Mailing Address - Fax:
Practice Address - Street 1:349 ST. KM. 2.7
Practice Address - Street 2:
Practice Address - City:MAYAGUEZ
Practice Address - State:PR
Practice Address - Zip Code:00680
Practice Address - Country:US
Practice Address - Phone:787-652-6031
Practice Address - Fax:787-805-3705
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BELLA VISTA HOSPITAL, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-09-12
Last Update Date:2011-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR400014Medicare PIN