Healthcare Provider Details

I. General information

NPI: 1083281927
Provider Name (Legal Business Name): VACCINES 360 LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/09/2021
Last Update Date: 06/14/2021
Certification Date: 06/14/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

BRISAS DE LAUREL 420 DIAMANTE STREET
PONCE PR
00780-2217
US

IV. Provider business mailing address

BRISAS DE LAUREL 420 DIAMANTE STREET
COTO LAUREL PR
00780
US

V. Phone/Fax

Practice location:
  • Phone: 787-362-9116
  • Fax: 787-260-6116
Mailing address:
  • Phone: 787-362-9116
  • Fax: 787-260-6116

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. WILFREDO J PEREZ VARGAS
Title or Position: VICE-PRESIDENT
Credential: MD
Phone: 787-362-9116