Provider Demographics
NPI:1023300803
Name:AGUADA MEDICAL CENTER, INC.
Entity type:Organization
Organization Name:AGUADA MEDICAL CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR MEDICO
Authorized Official - Prefix:DR
Authorized Official - First Name:HIRAM
Authorized Official - Middle Name:J
Authorized Official - Last Name:ORTEGA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-868-0345
Mailing Address - Street 1:PO BOX 90
Mailing Address - Street 2:
Mailing Address - City:AGUADA
Mailing Address - State:PR
Mailing Address - Zip Code:00602-0090
Mailing Address - Country:US
Mailing Address - Phone:787-868-0345
Mailing Address - Fax:787-868-0345
Practice Address - Street 1:CARRETERA 115
Practice Address - Street 2:KILOMETRO 24.5 BARRIO ASOMANTE
Practice Address - City:AGUADA
Practice Address - State:PR
Practice Address - Zip Code:00602
Practice Address - Country:US
Practice Address - Phone:787-868-0345
Practice Address - Fax:787-868-0345
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-11
Last Update Date:2020-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR=========OtherEIN