1831899855 NPI number — HOSPITAL MENONITA PONCE INC

Table of content: CRYSTAL ALENE WADDELL LCSWA (NPI 1295374569)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1831899855 NPI number — HOSPITAL MENONITA PONCE INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HOSPITAL MENONITA PONCE INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1831899855
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/08/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1650
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CIDRA
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00739-1650
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-901-5855
Provider Business Mailing Address Fax Number:
787-848-0022

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
CARR PR 506 KM 1.0, BO COTO LAUREL
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PONCE
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00780-0000
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-434-1700
Provider Business Practice Location Address Fax Number:
787-848-0022
Provider Enumeration Date:
03/08/2023

Additional Information

Authorized Official

Authorized Official Last Name:
VAZQUEZ RIVERA
Authorized Official First Name:
LISSETTE
Authorized Official Middle Name:
Authorized Official Title or Position:
DIRECTORA
Authorized Official Telephone Number:
787-434-1700

Provider Taxonomy Codes

  • Taxonomy code: 3336C0003X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: F-985081 . This is a "LICENCIA OPERACIONAL" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".




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