Healthcare Provider Details

I. General information

NPI: 1174952246
Provider Name (Legal Business Name): SISTEMA VIVA INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/08/2013
Last Update Date: 11/08/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

941 CALLE EIDER COUNTRY CLUB
SAN JUAN PR
00924-2335
US

IV. Provider business mailing address

RR 4 BOX 3494
BAYAMON PR
00956
US

V. Phone/Fax

Practice location:
  • Phone: 787-214-0941
  • Fax:
Mailing address:
  • Phone: 787-214-0941
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174H00000X
TaxonomyHealth Educator
License Number997478
License Number StatePR

VIII. Authorized Official

Name: MR. GILBERTO LUIS BAUZO II
Title or Position: DIRECTOR
Credential:
Phone: 787-214-0941