Healthcare Provider Details

I. General information

NPI: 1043726490
Provider Name (Legal Business Name): VACUNAS PLUS DE CAROLINA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/21/2017
Last Update Date: 12/21/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

VILLA CAROLINA 7-27 AVE ROBERTO CLEMENTE
CAROLINA PR
00985
US

IV. Provider business mailing address

PO BOX 3583
GUAYNABO PR
00970-3583
US

V. Phone/Fax

Practice location:
  • Phone: 787-528-0002
  • Fax:
Mailing address:
  • Phone: 787-528-0002
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License NumberSOL-11845-K9R7
License Number StatePR

VIII. Authorized Official

Name: CARLOS JAVIER PEREZ
Title or Position: PRESIDENT
Credential:
Phone: 787-528-0002