Healthcare Provider Details

I. General information

NPI: 1205439262
Provider Name (Legal Business Name): VACUNAS HEALTH CLINIC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/20/2020
Last Update Date: 11/20/2020
Certification Date: 09/18/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

JARDINES FAGOT CALLE AMARANTA B15
PONCE PR
00716
US

IV. Provider business mailing address

JARDINES FAGOT CALLE AMARANTA B15
PONCE PR
00716
US

V. Phone/Fax

Practice location:
  • Phone: 787-298-2795
  • Fax:
Mailing address:
  • Phone: 787-298-2795
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: CHRISTINE CAMARA CALVO
Title or Position: PRESIDENT
Credential:
Phone: 787-298-2795