Provider Demographics
NPI:1396794889
Name:FUNDACION DR MANUEL DE LA PILA IGLESIA
Entity type:Organization
Organization Name:FUNDACION DR MANUEL DE LA PILA IGLESIA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSE
Authorized Official - Middle Name:JOAQUIN
Authorized Official - Last Name:CORA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-848-5600
Mailing Address - Street 1:PO BOX 331910
Mailing Address - Street 2:
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00733-1910
Mailing Address - Country:US
Mailing Address - Phone:787-848-5600
Mailing Address - Fax:787-651-5686
Practice Address - Street 1:2431 AVE LAS AMERICAS
Practice Address - Street 2:
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00717-2113
Practice Address - Country:US
Practice Address - Phone:787-848-5600
Practice Address - Fax:787-651-5686
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-10
Last Update Date:2008-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR52273Y00000X, 282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
No273Y00000XHospital UnitsRehabilitation Unit
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR17021OtherTRIPLE S
PR7310040OtherHUMANA HEALTH PLAN
PR10021OtherTRIPLE S
PR10917OtherTRIPLE S
PR83838OtherTRIPLE S
PR030061OtherCRUZ AZUL
PRH4003OtherMEDICARE Y MUCHO MAS
PR18021OtherTRIPLE S
PR19021OtherTRIPLE S
PR40096OtherPREFERRED MEDICARE CHOICE
PR30037OtherTRIPLE S
PR84386OtherTRIPLE S
PR83838OtherTRIPLE S