Provider Demographics
NPI:1821374745
Name:CONVENTION HEALTH CENTER
Entity Type:Organization
Organization Name:CONVENTION HEALTH CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CORPORATE EXECUTIVE OFFICER
Authorized Official - Prefix:DR
Authorized Official - First Name:JESUS
Authorized Official - Middle Name:MANUEL
Authorized Official - Last Name:GALVEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-457-0974
Mailing Address - Street 1:PO BOX 7602
Mailing Address - Street 2:
Mailing Address - City:CAGUAS
Mailing Address - State:PR
Mailing Address - Zip Code:00726-7602
Mailing Address - Country:US
Mailing Address - Phone:787-457-0974
Mailing Address - Fax:787-724-4513
Practice Address - Street 1:AVE FERNANDEZ JUNCOS
Practice Address - Street 2:#600
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00907-3181
Practice Address - Country:US
Practice Address - Phone:787-969-3853
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-24
Last Update Date:2011-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty