Healthcare Provider Details

I. General information

NPI: 1326533134
Provider Name (Legal Business Name): VIP HEALTHCARE SOLUTIONS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/25/2018
Last Update Date: 06/25/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CARRETERA PR5 KM 2.8 EDIF JOB ANDUJAR
CATANO PR
00962
US

IV. Provider business mailing address

PO BOX 190442
SAN JUAN PR
00919-0442
US

V. Phone/Fax

Practice location:
  • Phone: 787-645-7605
  • Fax:
Mailing address:
  • Phone: 787-645-7605
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207PE0004X
TaxonomyEmergency Medical Services (Emergency Medicine) Physician
License Number18-074
License Number StatePR
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number18-074
License Number StatePR
# 3
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number18-074
License Number StatePR
# 4
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number18-074
License Number StatePR
# 5
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number18-074
License Number StatePR

VIII. Authorized Official

Name: MRS. IVELISSE RIVERA PADILLA
Title or Position: PRESIDENT
Credential: MHSO
Phone: 787-675-7605