Healthcare Provider Details

I. General information

NPI: 1730806100
Provider Name (Legal Business Name): ABC VACUNA T INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/25/2022
Last Update Date: 10/27/2022
Certification Date: 10/27/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

A4 AVE DEGETAU
CAGUAS PR
00725-4340
US

IV. Provider business mailing address

PO BOX 9525
CAGUAS PR
00726-9525
US

V. Phone/Fax

Practice location:
  • Phone: 787-501-8042
  • Fax:
Mailing address:
  • Phone: 787-501-8042
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MISS BARBARA DE LOURDES BRAVO
Title or Position: REGISTERED NURSE
Credential: RN
Phone: 787-932-0800