Provider Demographics
NPI:1497023972
Name:GUAYNABO HEALTH PROVIDERS, CORP.
Entity Type:Organization
Organization Name:GUAYNABO HEALTH PROVIDERS, CORP.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LILIANA
Authorized Official - Middle Name:MEDINA
Authorized Official - Last Name:OTERO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-720-5050
Mailing Address - Street 1:140 AVE LAS CUMBRES
Mailing Address - Street 2:SUITE 210
Mailing Address - City:GUAYNABO
Mailing Address - State:PR
Mailing Address - Zip Code:00969-5523
Mailing Address - Country:US
Mailing Address - Phone:787-720-5050
Mailing Address - Fax:787-720-4949
Practice Address - Street 1:140 AVE LAS CUMBRES
Practice Address - Street 2:GUAYNABO MEDICAL MALL
Practice Address - City:GUAYNABO
Practice Address - State:PR
Practice Address - Zip Code:00969-5523
Practice Address - Country:US
Practice Address - Phone:787-720-5050
Practice Address - Fax:787-720-4949
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-12
Last Update Date:2014-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
2085R0202X, 2085U0001X, 261QM1200X, 261QM1300X, 261QP2300X, 261QR0200X, 261QR0206X, 291U00000X
PR3261QE0002X
PR12-095261QE0002X
PR57261QE0002X
PR261QU0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QE0002XAmbulatory Health Care FacilitiesClinic/CenterEmergency Care
No2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
No2085U0001XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic UltrasoundGroup - Single Specialty
No261QM1200XAmbulatory Health Care FacilitiesClinic/CenterMagnetic Resonance Imaging (MRI)
No261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
No261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology
No261QR0206XAmbulatory Health Care FacilitiesClinic/CenterRadiology, Mammography
No261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
No291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
HB327AOtherMEDICARE PTAN