Healthcare Provider Details

I. General information

NPI: 1063330256
Provider Name (Legal Business Name): ATENCION PRIMARIA PORTA DEL SOL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/07/2026
Last Update Date: 07/07/2026
Certification Date: 07/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

611 PEDRO ALARCON MANSIONES DE ESPANA
MAYAGUEZ PR
00682
US

IV. Provider business mailing address

611 PEDRO ALARCON MANSIONES DE ESPANA
MAYAGUEZ PR
00682
US

V. Phone/Fax

Practice location:
  • Phone: 787-910-9308
  • Fax:
Mailing address:
  • Phone: 787-910-9308
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. VIVIAN ADELAIDA JUSTINIANO
Title or Position: ADMINISTRATOR
Credential: MD
Phone: 787-910-9308