Healthcare Provider Details

I. General information

NPI: 1376625210
Provider Name (Legal Business Name): VETERAN ADMINISTRATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/19/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

URB VALLE ANDALUCIA BOX3410
PONCE PR
00728
US

IV. Provider business mailing address

URB VALLE ANDALUCIA BOX3410
PONCE PR
00728
US

V. Phone/Fax

Practice location:
  • Phone: 787-614-4679
  • Fax:
Mailing address:
  • Phone: 787-614-4679
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code313M00000X
TaxonomyNursing Facility/Intermediate Care Facility
License Number11096
License Number StatePR

VIII. Authorized Official

Name: MISS BELEN RIVERA
Title or Position: NURSE SUPERVISOR
Credential:
Phone: 787-812-3030