# DR SUSONI HEALTH COMMUNITY SERVICES CORP

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** DR SUSONI HEALTH COMMUNITY SERVICES CORP
- **Other names:** Hospital Pavia Arecibo
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1053945022
- **Legal business name:** DR SUSONI HEALTH COMMUNITY SERVICES CORP
- **Authorized official:** JUAN L MEDINA (BILLING AND COLLECTIONS DIRECTOR)
- **Authorized official phone:** (787) 650-7272

## Contact information

- **Practice address:** CARR, 129 KM 1.0, AVE SAN LUIS, ARECIBO, PR 00613-0659
- **Practice address phone:** (787) 650-7272
- **Practice address fax:** (787) 650-7310
- **Mailing address:** PO BOX 659, ARECIBO, PR 00613-0659
- **Mailing address phone:** (787) 650-7272
- **Mailing address fax:** (787) 650-7310

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207L00000X | Anesthesiology Physician | — | NULL | Yes |
| 207L00000X | Anesthesiology Physician | — | — | Yes |
| 207RP1001X | Pulmonary Disease Physician | — | NULL | — |
| 207RP1001X | Pulmonary Disease Physician | — | — | — |
| 208800000X | Urology Physician | — | NULL | — |
| 208800000X | Urology Physician | — | — | — |

## Other

- **Enumeration date:** 02/27/2020
- **Last updated:** 09/26/2023

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 400087 | — | PR |