Healthcare Provider Details

I. General information

NPI: 1225560212
Provider Name (Legal Business Name): CENTRO DE VACUNACION SAB
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/30/2017
Last Update Date: 03/30/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5 CALLE PEDRO ALBIZU CAMPOS
AGUAS BUENAS PR
00703
US

IV. Provider business mailing address

PO BOX 1490
AGUAS BUENAS PR
00703-1490
US

V. Phone/Fax

Practice location:
  • Phone: 787-732-0755
  • Fax: 787-732-2205
Mailing address:
  • Phone: 787-732-0755
  • Fax: 787-732-2205

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code405300000X
TaxonomyPrevention Professional
License Number
License Number State

VIII. Authorized Official

Name: DR. AFREDO GONZALEZ
Title or Position: VICE PRESIDENT
Credential: MD
Phone: 787-732-8595