Healthcare Provider Details

I. General information

NPI: 1053764159
Provider Name (Legal Business Name): CENTRO DE VACUNACION FAMILIAR LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/13/2016
Last Update Date: 07/13/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

HC 8 BOX 24643
AGUADILLA PR
00603-9615
US

IV. Provider business mailing address

HC 8 BOX 24643
AGUADILLA PR
00603-9615
US

V. Phone/Fax

Practice location:
  • Phone: 787-629-3640
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number StateNULL

VIII. Authorized Official

Name: ZAIDA SALAS
Title or Position: PRESIDENT
Credential:
Phone: 787-629-3640