Provider Demographics
NPI:1093843278
Name:COMERIO MEDICAL HOSPITAL, INC.
Entity Type:Organization
Organization Name:COMERIO MEDICAL HOSPITAL, INC.
Other - Org Name:COMERIO MEDICAL PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENTE
Authorized Official - Prefix:
Authorized Official - First Name:LUIS
Authorized Official - Middle Name:MANUEL
Authorized Official - Last Name:GONZALEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-875-3136
Mailing Address - Street 1:PO BOX 1103
Mailing Address - Street 2:BO. PASARELL
Mailing Address - City:COMERIO
Mailing Address - State:PR
Mailing Address - Zip Code:00782-1103
Mailing Address - Country:US
Mailing Address - Phone:787-875-3136
Mailing Address - Fax:787-875-1434
Practice Address - Street 1:STREET 778 KM 0.9
Practice Address - Street 2:
Practice Address - City:COMERIO
Practice Address - State:PR
Practice Address - Zip Code:00782-1103
Practice Address - Country:US
Practice Address - Phone:787-875-3136
Practice Address - Fax:787-875-1434
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR07-F-21393336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR4024333OtherNABP