Provider Demographics
NPI:1376992040
Name:BELLA VISTA HOSPITAL
Entity Type:Organization
Organization Name:BELLA VISTA HOSPITAL
Other - Org Name:CENTRO PREVENTIVO MEDICINA DE FAMILIA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSE
Authorized Official - Middle Name:GUILLERMO
Authorized Official - Last Name:GRATACOS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-834-6000
Mailing Address - Street 1:PO BOX 424
Mailing Address - Street 2:
Mailing Address - City:MAYAGUEZ
Mailing Address - State:PR
Mailing Address - Zip Code:00681-0424
Mailing Address - Country:US
Mailing Address - Phone:787-834-6000
Mailing Address - Fax:787-805-3705
Practice Address - Street 1:AVE HOSTOS 770
Practice Address - Street 2:
Practice Address - City:MAYAGUEZ
Practice Address - State:PR
Practice Address - Zip Code:00680
Practice Address - Country:US
Practice Address - Phone:787-834-6160
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BELLA VISTA HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-06-03
Last Update Date:2016-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty