Provider Demographics
NPI:1871868547
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:
Authorized Official - Last Name:MEDINA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-720-5050
Mailing Address - Street 1:PMB 205 PO BOX 70344
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00936-8344
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:2012-03-14
Last Update Date:2012-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
No261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty