Healthcare Provider Details

I. General information

NPI: 1710444716
Provider Name (Legal Business Name): VICENTE COVAS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/26/2019
Last Update Date: 01/05/2024
Certification Date: 01/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

AVE AMERICO MIRANDA ESQ CENTRO MEDICO
SAN JUAN PR
00936
US

IV. Provider business mailing address

A6 CALLE 1 VILLAS DE LEVITTOWN
TOA BAJA PR
00949
US

V. Phone/Fax

Practice location:
  • Phone: 787-754-8500
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number36283-R
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: