Provider Demographics
NPI:1265594378
Name:HOSPITAL ANDRES GRILLASCA,INC
Entity type:Organization
Organization Name:HOSPITAL ANDRES GRILLASCA,INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF OPERATION OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:ELYONEL
Authorized Official - Middle Name:
Authorized Official - Last Name:PONTON
Authorized Official - Suffix:
Authorized Official - Credentials:COO
Authorized Official - Phone:787-848-0800
Mailing Address - Street 1:PO BOX 331324
Mailing Address - Street 2:
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00733-1324
Mailing Address - Country:US
Mailing Address - Phone:787-848-0800
Mailing Address - Fax:787-840-9732
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:00733-1324
Practice Address - Country:US
Practice Address - Phone:787-848-0800
Practice Address - Fax:787-840-9732
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR400028Medicare ID - Type Unspecified