Healthcare Provider Details

I. General information

NPI: 1689267213
Provider Name (Legal Business Name): VACUVIDA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/15/2021
Last Update Date: 05/20/2021
Certification Date: 05/04/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

C&C PROFESIONAL PLAZA CARR 335 KM 1.5 LOCAL 3
YAUCO PR
00698
US

IV. Provider business mailing address

URB HACIENDA FLORIDA CALLE JAZMIN #695
YAUCO PR
00698
US

V. Phone/Fax

Practice location:
  • Phone: 787-543-1482
  • Fax:
Mailing address:
  • Phone: 787-237-8623
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QI0500X
TaxonomyInfusion Therapy Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QP0905X
TaxonomyState or Local Public Health Clinic/Center
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ERIC H QUIRINDONGO
Title or Position: ADMINISTRATOR
Credential:
Phone: 787-543-1482