Provider Demographics
NPI:1407148976
Name:HOSPITAL ISAAC GONZALEZ MARTINEZ
Entity Type:Organization
Organization Name:HOSPITAL ISAAC GONZALEZ MARTINEZ
Other - Org Name:CENTRO COMPRESIVO DE LA MUJER Y ADOLECENTE HOSPITAL ISAA
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT BORD OF DIRECTORS
Authorized Official - Prefix:MRS
Authorized Official - First Name:ILIA
Authorized Official - Middle Name:
Authorized Official - Last Name:GARCIA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-763-4149
Mailing Address - Street 1:PO BOX 191811
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00919-1811
Mailing Address - Country:US
Mailing Address - Phone:787-763-4149
Mailing Address - Fax:
Practice Address - Street 1:BARRIO MONACILLO SECTOR CENTRO MEDICO
Practice Address - Street 2:
Practice Address - City:RIO PIEDRAS
Practice Address - State:PR
Practice Address - Zip Code:00935
Practice Address - Country:US
Practice Address - Phone:787-763-4149
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HOSPITAL ISAAC GONZALEZ MARTINEZ
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-05-03
Last Update Date:2011-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR65284300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes284300000XHospitalsSpecial Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR400012Medicare Oscar/Certification
PR400012Medicare UPIN