Provider Demographics
NPI:1407859036
Name:DEPARTAMENTO DE SALUD OFICIAL
Entity Type:Organization
Organization Name:DEPARTAMENTO DE SALUD OFICIAL
Other - Org Name:UDH
Other - Org Type:Other Name
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JORGE
Authorized Official - Middle Name:E
Authorized Official - Last Name:MATTA
Authorized Official - Suffix:SR
Authorized Official - Credentials:MHSA
Authorized Official - Phone:787-754-0101
Mailing Address - Street 1:PO BOX 2116
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00921-2116
Mailing Address - Country:US
Mailing Address - Phone:787-753-7984
Mailing Address - Fax:787-763-3684
Practice Address - Street 1:CARR 22 AVE AMERICO MIRANDA BO MONACILLO
Practice Address - Street 2:
Practice Address - City:RIO PIEDRAS
Practice Address - State:PR
Practice Address - Zip Code:00921
Practice Address - Country:US
Practice Address - Phone:787-754-0101
Practice Address - Fax:787-763-3684
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-05-27
Last Update Date:2012-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR3282N00000X
PR282NC0060X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
No282NC0060XHospitalsGeneral Acute Care HospitalCritical Access
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR030450011SJOtherSANITARY LICENSE NUMBER
PR04136OtherSTATE CNC NUMBER
PR3OtherSTATE LINCENSE NUM.
PR04136OtherSTATE CNC NUMBER