Provider Demographics
NPI:1194169185
Name:MAYAGUEZ AMBULATORY SURGICAL CENTER
Entity type:Organization
Organization Name:MAYAGUEZ AMBULATORY SURGICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:ANGIE
Authorized Official - Middle Name:L
Authorized Official - Last Name:JIMENEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MHSA
Authorized Official - Phone:787-522-2825
Mailing Address - Street 1:CITY VIEW PLAZA 1010
Mailing Address - Street 2:STREET 165 KM 1.2 # 48
Mailing Address - City:GUAYNABO
Mailing Address - State:PR
Mailing Address - Zip Code:00968
Mailing Address - Country:US
Mailing Address - Phone:787-522-2825
Mailing Address - Fax:787-522-2848
Practice Address - Street 1:MAYAGUEZ TOWN CENTER
Practice Address - Street 2:POST STREET # 252 LOCAL 1
Practice Address - City:MAYAGUEZ
Practice Address - State:PR
Practice Address - Zip Code:00680
Practice Address - Country:US
Practice Address - Phone:787-522-2825
Practice Address - Fax:787-522-2848
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-22
Last Update Date:2013-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical