Provider Demographics
NPI:1285648006
Name:HOSPITAL ESPANOL AUXILIO MUTUO DEPUERTO RICO, INC.
Entity Type:Organization
Organization Name:HOSPITAL ESPANOL AUXILIO MUTUO DEPUERTO RICO, INC.
Other - Org Name:CENTRO IMAGENES DE LA MUJER
Other - Org Type:Other Name
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JORGE
Authorized Official - Middle Name:L
Authorized Official - Last Name:MATTA
Authorized Official - Suffix:
Authorized Official - Credentials:MHSA
Authorized Official - Phone:787-758-2000
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:787-758-2000
Mailing Address - Fax:787-771-7975
Practice Address - Street 1:735 AVE PONCE DE LEON
Practice Address - Street 2:STOP 37.5
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00917-5022
Practice Address - Country:US
Practice Address - Phone:787-758-2000
Practice Address - Fax:787-771-7927
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR66048690CIMOtherCOSVI-IMAGENES MUJER
PR84886OtherSSS-IMAGENES MUJER
PR9360154OtherHUMANA-IMAGENES MUJER
PR511355OtherPREFERRED-IMAGENES MUJER
PR9360154OtherHUMANA-IMAGENES MUJER
PR=========3AOtherMCS-IMAGENES DE MUJER
PR84886OtherSSS-IMAGENES MUJER