Basic Information
| Provider Information | |||||||||
| NPI: | 1124170261 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | HOSPITAL UNIVERSITARIO DE ADULTOS | ||||||||
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| Credential: | |||||||||
| OtherOrganizationName: | UDH | ||||||||
| OtherOrganizationType: | 4 | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 2116 | ||||||||
| Address2: | CENTRO MEDICO DE PUERTO RICO CENTRO RENAL | ||||||||
| City: | SAN JUAN | ||||||||
| State: | PR | ||||||||
| PostalCode: | 009222116 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7877540101 | ||||||||
| FaxNumber: | 7877633684 | ||||||||
| Practice Location | |||||||||
| Address1: | MONACILLO ST. 2116 | ||||||||
| Address2: | CENTRO MEDICO DE PUERTO RICO CENTRO RENAL | ||||||||
| City: | SAN JUAN | ||||||||
| State: | PR | ||||||||
| PostalCode: | 009222116 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7877540101 | ||||||||
| FaxNumber: | 7877633684 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/17/2007 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | MORALES | ||||||||
| AuthorizedOfficialFirstName: | MARIELA | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | DIRECTORA FACTURACION Y COBRO | ||||||||
| AuthorizedOfficialTelephone: | 7877540101 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261Q00000X | 33 | PR | Y | Ambulatory Health Care Facilities | Clinic/Center |
No ID Information.