Healthcare Provider Details

I. General information

NPI: 1477487148
Provider Name (Legal Business Name): EMUNA MEDICINE & AESTHETICS CLINIC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/09/2026
Last Update Date: 06/09/2026
Certification Date: 06/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

190 CALLE DR SUSONI
HATILLO PR
00659-2278
US

IV. Provider business mailing address

PO BOX 418
CAMUY PR
00627-0418
US

V. Phone/Fax

Practice location:
  • Phone: 939-353-0970
  • Fax:
Mailing address:
  • Phone: 939-353-0970
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. KEVIN O ALICEA VARGAS
Title or Position: OWNER
Credential: MD
Phone: 787-612-0429