Provider Demographics
NPI:1114143187
Name:FARMACIA HOSPITAL MENONITA
Entity type:Organization
Organization Name:FARMACIA HOSPITAL MENONITA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:RUBEN
Authorized Official - Middle Name:
Authorized Official - Last Name:NORAT
Authorized Official - Suffix:
Authorized Official - Credentials:LCDO
Authorized Official - Phone:787-735-8001
Mailing Address - Street 1:PO BOX 1379
Mailing Address - Street 2:
Mailing Address - City:AIBONITO
Mailing Address - State:PR
Mailing Address - Zip Code:00705-1379
Mailing Address - Country:US
Mailing Address - Phone:787-735-8001
Mailing Address - Fax:787-735-0384
Practice Address - Street 1:CALLE JOSE C VAZQUEZ
Practice Address - Street 2:ESQ DR. TROYER
Practice Address - City:AIBONITO
Practice Address - State:PR
Practice Address - Zip Code:00705
Practice Address - Country:US
Practice Address - Phone:787-735-8001
Practice Address - Fax:787-735-0384
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR09-F-0513282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR400018Medicare ID - Type Unspecified