Provider Demographics
NPI:1104862044
Name:HOSPITAL DR. SUSONI. INC.
Entity Type:Organization
Organization Name:HOSPITAL DR. SUSONI. INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ANGEL
Authorized Official - Middle Name:
Authorized Official - Last Name:ALVAREZ
Authorized Official - Suffix:
Authorized Official - Credentials:MHSA
Authorized Official - Phone:787-650-1031
Mailing Address - Street 1:PO BOX 145200
Mailing Address - Street 2:
Mailing Address - City:ARECIBO
Mailing Address - State:PR
Mailing Address - Zip Code:00614-5200
Mailing Address - Country:US
Mailing Address - Phone:787-650-1030
Mailing Address - Fax:787-650-1040
Practice Address - Street 1:55 CALLE PALMA
Practice Address - Street 2:
Practice Address - City:ARECIBO
Practice Address - State:PR
Practice Address - Zip Code:00612-4526
Practice Address - Country:US
Practice Address - Phone:787-650-1030
Practice Address - Fax:787-650-1040
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-21
Last Update Date:2016-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR32CNC04196282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR400117Medicare ID - Type Unspecified