Healthcare Provider Details

I. General information

NPI: 1962966119
Provider Name (Legal Business Name): VACUNACION AL DIA NINOS Y ADULTOS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/22/2019
Last Update Date: 01/22/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22-2 CALLE 18 URB VILLA CAROLINA
CAROLINA PR
00985
US

IV. Provider business mailing address

22-2 CALLE 18 URB VILLA CAROLINA
CAROLINA PR
00985
US

V. Phone/Fax

Practice location:
  • Phone: 787-701-5860
  • Fax:
Mailing address:
  • Phone: 787-701-5860
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: RAISA AIMME RODRIGUEZ
Title or Position: OWNER
Credential:
Phone: 787-701-5860