Healthcare Provider Details

I. General information

NPI: 1144326398
Provider Name (Legal Business Name): VACUNACION DEL NORTE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/15/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CARRETERA 681 KM 4.5 INT BO ISLOTE
ARECIBO PR
00614
US

IV. Provider business mailing address

PO BOX 140187
ARECIBO PR
00614-0187
US

V. Phone/Fax

Practice location:
  • Phone: 787-344-1328
  • Fax: 787-817-0494
Mailing address:
  • Phone: 787-344-1328
  • Fax: 787-817-0494

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number07B3151
License Number StatePR

VIII. Authorized Official

Name: MRS. CARMEN TORRES BERROCAL
Title or Position: DIRECTORA EJECUTIVA
Credential:
Phone: 787-344-1328