Healthcare Provider Details

I. General information

NPI: 1366060766
Provider Name (Legal Business Name): PREPVEN CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/12/2020
Last Update Date: 01/10/2022
Certification Date: 01/10/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

315 CALLE MANUEL DOMENECH STE 1
SAN JUAN PR
00918-3513
US

IV. Provider business mailing address

315 AVE MANUEL DOMENECH STE 1
SAN JUAN PR
00918-3513
US

V. Phone/Fax

Practice location:
  • Phone: 787-918-8618
  • Fax:
Mailing address:
  • Phone: 787-918-8618
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: RONALD COLLAZO PAGAN
Title or Position: DIRECTOR
Credential: MD
Phone: 787-918-8618