Healthcare Provider Details

I. General information

NPI: 1437263779
Provider Name (Legal Business Name): CORPORACION LAS VEGAS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/17/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

ROAD NO. 2 KM 46.4 EDIF LAS VEGAS #420, BO CAMPO ALEGRE
MANATI PR
00674-1086
US

IV. Provider business mailing address

PO BOX 1086 RD #2, LAS VEGAS BLDG. #420, BO CAMPO ALEGRE KM 46.4
MANATI PR
00674-1086
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0401X
TaxonomyComprehensive Outpatient Rehabilitation Facility (CORF)
License Number#14
License Number StatePR

VIII. Authorized Official

Name: MR. MIGUEL A VAZQUEZ
Title or Position: PRESIDENT
Credential:
Phone: 787-854-1426