Provider Demographics
NPI:1104856889
Name:HOSPITAL SAN CARLOS INCORPORADO
Entity type:Organization
Organization Name:HOSPITAL SAN CARLOS INCORPORADO
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:SARAH
Authorized Official - Middle Name:I
Authorized Official - Last Name:VILLANUEVA
Authorized Official - Suffix:
Authorized Official - Credentials:MHSA
Authorized Official - Phone:787-877-8000
Mailing Address - Street 1:PO BOX 68
Mailing Address - Street 2:
Mailing Address - City:MOCA
Mailing Address - State:PR
Mailing Address - Zip Code:00676-0068
Mailing Address - Country:US
Mailing Address - Phone:787-877-8000
Mailing Address - Fax:787-877-5610
Practice Address - Street 1:CARR. 110 BARRIO PUEBLO
Practice Address - Street 2:CALLE CONCEPCION VERA NUM. 550 S.
Practice Address - City:MOCA
Practice Address - State:PR
Practice Address - Zip Code:00676-0068
Practice Address - Country:US
Practice Address - Phone:787-877-8000
Practice Address - Fax:787-877-5610
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-05
Last Update Date:2024-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
207RC0000X, 207RP1001X, 208600000X
PR20282NR1301X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes282NR1301XHospitalsGeneral Acute Care HospitalRural
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Multi-Specialty
No207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Multi-Specialty
No208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR84949Medicare PIN
PR83519Medicare PIN
PR400111Medicare ID - Type Unspecified