Healthcare Provider Details

I. General information

NPI: 1588809735
Provider Name (Legal Business Name): VA MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/02/2008
Last Update Date: 12/02/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 CALLE CASIA SAN JUAN PR
SAN JUAN PR
00921-3200
US

IV. Provider business mailing address

10 CALLE CASIA SAN JUAN PR
SAN JUAN PR
00921-3200
US

V. Phone/Fax

Practice location:
  • Phone: 787-641-7582
  • Fax:
Mailing address:
  • Phone: 787-641-7582
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code273Y00000X
TaxonomyRehabilitation Hospital Unit
License NumberCP003225
License Number StatePR

VIII. Authorized Official

Name: PABLO LOPEZ
Title or Position: CHIEF PSAS
Credential:
Phone: 787-641-7582