Healthcare Provider Details

I. General information

NPI: 1194311712
Provider Name (Legal Business Name): DOCTORAS ZARAGOZA- VACUNAS Y CERTIFICADOS DE SALUD LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/17/2020
Last Update Date: 09/28/2021
Certification Date: 09/28/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

909 AVE TITO CASTRO SUITE 717 TORRE MEDICA SAN LUCAS
PONCE PR
00716-0071
US

IV. Provider business mailing address

PMB 157 PO BOX 780
MERCEDITA PR
00715
US

V. Phone/Fax

Practice location:
  • Phone: 787-841-5549
  • Fax: 787-840-3030
Mailing address:
  • Phone: 787-841-5549
  • Fax: 787-840-3030

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code302R00000X
TaxonomyHealth Maintenance Organization
License Number
License Number State

VIII. Authorized Official

Name: CELLYMAR ZARAGOZA RIVERA
Title or Position: DOCTOR
Credential: MD
Phone: 787-841-5549