Provider Demographics
NPI:1992131270
Name:HOSPITAL INFANTIL DE SAN JOSE
Entity type:Organization
Organization Name:HOSPITAL INFANTIL DE SAN JOSE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:RESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:HECTOR
Authorized Official - Middle Name:ANDRES
Authorized Official - Last Name:RODRIGUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-626-5135
Mailing Address - Street 1:151 AVE
Mailing Address - Street 2:
Mailing Address - City:BOGOTA
Mailing Address - State:BOGOTA
Mailing Address - Zip Code:472
Mailing Address - Country:CO
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:151 AVE
Practice Address - Street 2:
Practice Address - City:BOGOTA
Practice Address - State:BOGOTA
Practice Address - Zip Code:472
Practice Address - Country:CO
Practice Address - Phone:571-626-5135
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-18
Last Update Date:2013-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes284300000XHospitalsSpecial Hospital