Provider Demographics
NPI:1619194305
Name:HOSPITAL ANDRES GRILLASCA,INC.
Entity Type:Organization
Organization Name:HOSPITAL ANDRES GRILLASCA,INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
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:TITO CASTRO AVE.CARR.14 BO.MACHUELO
Mailing Address - Street 2:
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00733
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
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:2007-04-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR21174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty