Healthcare Provider Details

I. General information

NPI: 1659364248
Provider Name (Legal Business Name): CORPORACION LAS VEGAS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/29/2005
Last Update Date: 04/02/2025
Certification Date: 04/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CARR 2 EDIF LAS VEGAS #420, BO CAMPO ALEGRE
MANATI PR
00674-5765
US

IV. Provider business mailing address

PO BOX 1086 RD #2, LAS VEGAS BLDG. #420, BO CAMPO ALEGRE
MANATI PR
00674-1086
US

V. Phone/Fax

Practice location:
  • Phone: 787-854-1426
  • Fax: 787-884-3757
Mailing address:
  • Phone: 787-854-1426
  • Fax: 787-884-3757

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: MRS. ISAMAR HASSAN PEREZ
Title or Position: EXECUTIVE DIRECTOR
Credential: RPT
Phone: 787-854-1426