Healthcare Provider Details

I. General information

NPI: 1700161684
Provider Name (Legal Business Name): CENTRO TERAPEUTICO VIMAR, PSC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/11/2011
Last Update Date: 10/11/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

27-16 AVE ROBERTO CLEMENTE VILLA CAROLINA
CAROLINA PR
00985-5420
US

IV. Provider business mailing address

27-16 AVE ROBERTO CLEMENTE VILLA CAROLINA
CAROLINA PR
00985-5420
US

V. Phone/Fax

Practice location:
  • Phone: 787-276-8123
  • Fax:
Mailing address:
  • Phone: 787-276-8123
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number730
License Number StatePR

VIII. Authorized Official

Name: VILMA J VALENTIN
Title or Position: PRESIDENTE
Credential: MSPHL
Phone: 787-276-8123