Healthcare Provider Details

I. General information

NPI: 1952708042
Provider Name (Legal Business Name): BV INFANT NUTRITION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/04/2014
Last Update Date: 12/04/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

LOCAL #5 CALLE RAMON DE JESUS SIERRA
LARES PR
00669
US

IV. Provider business mailing address

PO BOX 187
CATANO PR
00963-0187
US

V. Phone/Fax

Practice location:
  • Phone: 939-640-2052
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code343800000X
TaxonomySecured Medical Transport (VAN)
License Number
License Number State

VIII. Authorized Official

Name: MR. WILLIAM R DIAZ JR.
Title or Position: PRESIDENT
Credential:
Phone: 939-640-2052