Healthcare Provider Details

I. General information

NPI: 1932114899
Provider Name (Legal Business Name): DEPARTMENT OF VETERANS AFFAIRS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/29/2006
Last Update Date: 06/25/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1010 PASEO DEL VETERANO
PONCE PR
00716-2001
US

IV. Provider business mailing address

1010 PASEO DEL VETERANO
PONCE PR
00716-2001
US

V. Phone/Fax

Practice location:
  • Phone: 787-812-3030
  • Fax: 787-651-4334
Mailing address:
  • Phone: 787-812-3030
  • Fax: 787-651-4334

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number1626
License Number StatePR

VIII. Authorized Official

Name: MS. MARIA M MONTALVO
Title or Position: SOCIAL WORKER
Credential: MSW
Phone: 787-812-3030