Provider Demographics
NPI:1215408927
Name:HOSPITAL ESPANOL AUXILIO MUTUO DE PUERTO RICO, INC.
Entity Type:Organization
Organization Name:HOSPITAL ESPANOL AUXILIO MUTUO DE PUERTO RICO, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSSINES OFFICE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:RAFAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:JACA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-771-7934
Mailing Address - Street 1:PO BOX 191227
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00919-1227
Mailing Address - Country:US
Mailing Address - Phone:787-771-7934
Mailing Address - Fax:787-771-4702
Practice Address - Street 1:715 AVE PONCE DE LEON STOP 37.5
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00917-5032
Practice Address - Country:US
Practice Address - Phone:787-771-7934
Practice Address - Fax:787-771-7402
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:RADIOLOGOS AUXILIO MUTUO
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-12-07
Last Update Date:2018-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty