Healthcare Provider Details

I. General information

NPI: 1255158168
Provider Name (Legal Business Name): VIVO CLINIC CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/23/2024
Last Update Date: 03/18/2026
Certification Date: 03/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

D-2 AVE SAN DEMETRIO
VEGA BAJA PR
00693-5136
US

IV. Provider business mailing address

PO BOX 2232
VEGA BAJA PR
00694-2232
US

V. Phone/Fax

Practice location:
  • Phone: 787-960-3160
  • Fax:
Mailing address:
  • Phone: 787-960-3160
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name: JORGE M ROQUE
Title or Position: PRESIDENT
Credential: DC
Phone: 787-960-3160