Healthcare Provider Details

I. General information

NPI: 1083175434
Provider Name (Legal Business Name): VISTA CARE GROUP LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/28/2019
Last Update Date: 03/28/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

URB SANTA JUANITA P60 AVE SANTA JUANITA
BAYAMON PR
00956
US

IV. Provider business mailing address

URB SANTA JUANITA P60 AVE SANTA JUANITA
BAYAMON PR
00956
US

V. Phone/Fax

Practice location:
  • Phone: 787-955-2450
  • Fax: 787-787-2424
Mailing address:
  • Phone: 787-955-2450
  • Fax: 787-787-2424

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332H00000X
TaxonomyEyewear Supplier
License Number
License Number State

VIII. Authorized Official

Name: AMARILIS SANTIAGO
Title or Position: OWNER
Credential:
Phone: 787-904-7682