Healthcare Provider Details

I. General information

NPI: 1043715287
Provider Name (Legal Business Name): VIP MEDICAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/29/2018
Last Update Date: 03/29/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

L2 CALLE 7 URB SAN FERNANDO
TOA ALTA PR
00953
US

IV. Provider business mailing address

P.O. BOX 1212
TOA ALTA PR
00954-1212
US

V. Phone/Fax

Practice location:
  • Phone: 787-870-4704
  • Fax: 787-870-3756
Mailing address:
  • Phone: 787-870-4704
  • Fax: 787-870-3756

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code302R00000X
TaxonomyHealth Maintenance Organization
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JANIZABETH VAZQUEZ
Title or Position: ADMINISTRATOR
Credential:
Phone: 787-554-8129