Healthcare Provider Details

I. General information

NPI: 1205132867
Provider Name (Legal Business Name): DEPARTMENT OF VETERAN AFFAIRS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/31/2011
Last Update Date: 01/31/2011
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

ST SANTIAGO IGLESIAS # 4
COAMO PR
00769
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QV0200X
TaxonomyVA Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. FERNANDO CARTAGENA
Title or Position: ADDICTION THERAPIST
Credential:
Phone: 787-812-3030