Provider Demographics
NPI:1992253637
Name:GUAYNABO HEALTH PROVIDERS, CORP.
Entity type:Organization
Organization Name:GUAYNABO HEALTH PROVIDERS, CORP.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LILIANA
Authorized Official - Middle Name:
Authorized Official - Last Name:MEDINA OTERO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-720-5050
Mailing Address - Street 1:140 AVE LAS CUMBRES
Mailing Address - Street 2:SUITE 210
Mailing Address - City:GUAYNABO
Mailing Address - State:PR
Mailing Address - Zip Code:00969
Mailing Address - Country:US
Mailing Address - Phone:787-720-5050
Mailing Address - Fax:787-720-4949
Practice Address - Street 1:45 CALLE DIEGO VEGA
Practice Address - Street 2:BARRIO AMELIA
Practice Address - City:GUAYNABO
Practice Address - State:PR
Practice Address - Zip Code:00965
Practice Address - Country:US
Practice Address - Phone:787-705-5858
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-12
Last Update Date:2016-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0002XAmbulatory Health Care FacilitiesClinic/CenterEmergency Care
No261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
No261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology
No291U00000XLaboratoriesClinical Medical Laboratory