Provider Demographics
NPI:1336346105
Name:GRUPO ENT FACULTAD MEDICA HMSJ
Entity type:Organization
Organization Name:GRUPO ENT FACULTAD MEDICA HMSJ
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:LISETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:PEREZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-766-2222
Mailing Address - Street 1:PMB 101 BOX 70344
Mailing Address - Street 2:CMMS 101
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00936-8344
Mailing Address - Country:US
Mailing Address - Phone:787-766-2222
Mailing Address - Fax:787-765-4975
Practice Address - Street 1:AC31 CALLE 45
Practice Address - Street 2:SANTA JUANITA
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00956-4753
Practice Address - Country:US
Practice Address - Phone:787-766-2222
Practice Address - Fax:787-765-4975
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR28030Medicare ID - Type UnspecifiedGRUPO ENT HMLN