Healthcare Provider Details

I. General information

NPI: 1144785841
Provider Name (Legal Business Name): VPS MEDICAL GROUP LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/06/2019
Last Update Date: 05/07/2025
Certification Date: 04/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1396 CALLE SAN RAFAEL MEDICAL PAVILION SUITE 15
SAN JUAN PR
00909
US

IV. Provider business mailing address

1341 CALLE ALDEA APT TH5
SAN JUAN PR
00907-2321
US

V. Phone/Fax

Practice location:
  • Phone: 787-590-8584
  • Fax: 939-715-1061
Mailing address:
  • Phone: 787-590-8584
  • Fax: 787-254-9573

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: ALFRED VALDIVIESO RODRIGUEZ
Title or Position: PRESIDENT
Credential: MD
Phone: 787-590-8584