Healthcare Provider Details

I. General information

NPI: 1346678711
Provider Name (Legal Business Name): VACUNAS PLUS PONCE, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/23/2013
Last Update Date: 10/23/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CALLE FERROCARRIL ESQUINA MARINA 9105 SEGUNDO PISO EDIF ORENGO MEDICAL BUILDING
PONCE PR
00717
US

IV. Provider business mailing address

PO BOX 3583
GUAYNABO PR
00970-3583
US

V. Phone/Fax

Practice location:
  • Phone: 787-624-9994
  • Fax:
Mailing address:
  • Phone: 787-624-9994
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number StatePR

VIII. Authorized Official

Name: MRS. TAMARA VALLS
Title or Position: OWNER
Credential:
Phone: 787-624-9994