Provider Demographics
NPI:1619193539
Name:HOSPITAL ANDRES GRILLASCA,INC,
Entity Type:Organization
Organization Name:HOSPITAL ANDRES GRILLASCA,INC,
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXCUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:MANUEL
Authorized Official - Middle Name:J
Authorized Official - Last Name:VAZQUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MHSA
Authorized Official - Phone:787-848-0800
Mailing Address - Street 1:PO BOX 331324
Mailing Address - Street 2:
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00733-1324
Mailing Address - Country:US
Mailing Address - Phone:787-848-0800
Mailing Address - Fax:787-843-2310
Practice Address - Street 1:TITO CASTRO AVE.CARR. 14 BO. MACHUELO
Practice Address - Street 2:
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00733-1324
Practice Address - Country:US
Practice Address - Phone:787-848-0800
Practice Address - Fax:787-843-2310
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-18
Last Update Date:2011-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR12174400000X, 261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
No174400000XOther Service ProvidersSpecialistGroup - Single Specialty