Provider Demographics
NPI:1891424891
Name:HOSPITAL MENONITA HUMACAO INC
Entity Type:Organization
Organization Name:HOSPITAL MENONITA HUMACAO INC
Other - Org Name:RED AMBULATORIA MENONITA (CENTRO DE DIAGNOSTICO Y TRATAMIENTO)
Other - Org Type:Other Name
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:LISSETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:VASQUEZ RIVERA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-434-1700
Mailing Address - Street 1:PO BOX 1650
Mailing Address - Street 2:
Mailing Address - City:CIDRA
Mailing Address - State:PR
Mailing Address - Zip Code:00739-1650
Mailing Address - Country:US
Mailing Address - Phone:787-434-1700
Mailing Address - Fax:787-434-1711
Practice Address - Street 1:AVE. BOULEVARD SUR, TORRE III
Practice Address - Street 2:BOULEVARD DEL RIO OFFICE CENTER BO RIO ABAJO
Practice Address - City:HUMACAO
Practice Address - State:PR
Practice Address - Zip Code:00792-8888
Practice Address - Country:US
Practice Address - Phone:787-434-1700
Practice Address - Fax:787-434-1711
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-07
Last Update Date:2022-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0002XAmbulatory Health Care FacilitiesClinic/CenterEmergency Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR88OtherLICENCIA OPERACIONAL