Healthcare Provider Details

I. General information

NPI: 1255879474
Provider Name (Legal Business Name): CENTRO DE VACUNACION Y SERVIVIOS INTEGRADOS DE SALUD,INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/08/2017
Last Update Date: 02/08/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CARRETERA 402 4.6KM BOX PINALES
ANASCO PR
00610
US

IV. Provider business mailing address

RR 2 BOX 2725
ANASCO PR
00610-9602
US

V. Phone/Fax

Practice location:
  • Phone: 787-229-1110
  • Fax: 787-229-1110
Mailing address:
  • Phone: 787-229-1110
  • Fax: 787-229-1110

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number029804
License Number StatePR
# 2
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number14771
License Number StatePR

VIII. Authorized Official

Name: MR. ADOLFO MATIAS
Title or Position: ADMINISTRATOR
Credential:
Phone: 787-229-1110