Provider Demographics
NPI:1669789038
Name:GRUPO MEDICO HOSPITAL SAN JUAN CAPESTRANO
Entity type:Organization
Organization Name:GRUPO MEDICO HOSPITAL SAN JUAN CAPESTRANO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:
Authorized Official - Last Name:VARGAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-760-0222
Mailing Address - Street 1:RR 2 BOX 11
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00926-9767
Mailing Address - Country:US
Mailing Address - Phone:787-760-0222
Mailing Address - Fax:787-760-0125
Practice Address - Street 1:CARR 877 KM 1.6 CAMINO LAS LOMAS
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00926-9767
Practice Address - Country:US
Practice Address - Phone:787-760-0222
Practice Address - Fax:787-760-0125
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HOSPITAL SAN JUAN CAPESTRANO
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-09-08
Last Update Date:2010-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty