Healthcare Provider Details

I. General information

NPI: 1720239536
Provider Name (Legal Business Name): VG MEDICINA AL HOGAR INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/10/2008
Last Update Date: 10/10/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CARR 115 KM 12 BO PUEBLO VISTAMAR PLAZA 6
RINCON PR
00677
US

IV. Provider business mailing address

PO BOX 486
RINCON PR
00677-0486
US

V. Phone/Fax

Practice location:
  • Phone: 939-969-4257
  • Fax:
Mailing address:
  • Phone: 939-969-4257
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QI0500X
TaxonomyInfusion Therapy Clinic/Center
License Number14468
License Number StatePR

VIII. Authorized Official

Name: DR. JAVIER SALAS RIVERA
Title or Position: PRESIDENTE
Credential: M.D.
Phone: 939-969-4257