Healthcare Provider Details

I. General information

NPI: 1699723676
Provider Name (Legal Business Name): NEW VISION MEDICAL ADVISORY GROUP, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/04/2006
Last Update Date: 06/29/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

AVE. BATANCES J-23 URB. HERMANAS DAVILA BAYAMON MEDICAL MALL
BAYAMON PR
00961-5350
US

IV. Provider business mailing address

PO BOX 6350
BAYAMON PR
00960-5350
US

V. Phone/Fax

Practice location:
  • Phone: 787-778-5311
  • Fax: 787-778-5302
Mailing address:
  • Phone: 787-778-5311
  • Fax: 787-778-5302

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number StatePR

VIII. Authorized Official

Name: MR. JOSE JOAQUIN VARGAS
Title or Position: PRESIDENT
Credential:
Phone: 787-778-5311