Healthcare Provider Details

I. General information

NPI: 1295385508
Provider Name (Legal Business Name): VACUNAS DEL SUR INCORPORADO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/18/2019
Last Update Date: 09/18/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

AVE UNIVERSIDAD INTERAMERICANA 187 SUITE 109
SAN GERMAN PR
00683
US

IV. Provider business mailing address

PO BOX 7763
PONCE PR
00732-7763
US

V. Phone/Fax

Practice location:
  • Phone: 787-955-5525
  • Fax:
Mailing address:
  • Phone: 787-425-9012
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MARCOS RIVERA
Title or Position: PRESIDENT
Credential:
Phone: 787-425-9012