Healthcare Provider Details

I. General information

NPI: 1386448587
Provider Name (Legal Business Name): COAMO PRIMARY HEALTHCARE SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/04/2025
Last Update Date: 04/04/2025
Certification Date: 04/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

94 CALLE JOSE I QUINTON
COAMO PR
00769-3107
US

IV. Provider business mailing address

94 CALLE JOSE I QUINTON
COAMO PR
00769-3107
US

V. Phone/Fax

Practice location:
  • Phone: 787-404-9005
  • Fax:
Mailing address:
  • Phone: 787-404-9005
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code133N00000X
TaxonomyNutritionist
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number
License Number State

VIII. Authorized Official

Name: DR. KARIM SALEH VEGA
Title or Position: PRESIDENT
Credential:
Phone: 787-404-9005