Healthcare Provider Details

I. General information

NPI: 1215371406
Provider Name (Legal Business Name): VACCINE FOR KIDS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/18/2013
Last Update Date: 04/18/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

HC 3 BOX 26509
SAN GERMAN PR
00683-9301
US

IV. Provider business mailing address

HC-3 BOX 26509
SAN GERMAN PR
00683
US

V. Phone/Fax

Practice location:
  • Phone: 787-505-2543
  • Fax:
Mailing address:
  • Phone: 787-505-2543
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number9270
License Number StatePR

VIII. Authorized Official

Name: DR. MIGUEL A SUAREZ
Title or Position: PRESIDENT
Credential:
Phone: 787-505-2543