Healthcare Provider Details

I. General information

NPI: 1285287979
Provider Name (Legal Business Name): VIRGIN ISLANDS HEALTHCARE FOUNDATION, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/22/2019
Last Update Date: 04/30/2025
Certification Date: 04/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3004 ORANGE GROVE SUITE 2
CHRISTIANSTED VI
00820-4288
US

IV. Provider business mailing address

3004 ORANGE GROVE SUITE 2
CHRISTIANSTED VI
00820-4288
US

V. Phone/Fax

Practice location:
  • Phone: 340-715-7720
  • Fax: 340-713-9002
Mailing address:
  • Phone: 340-715-7720
  • Fax: 340-713-9002

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QE0700X
TaxonomyEnd-Stage Renal Disease (ESRD) Treatment Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. JAN BIJAN TAWAKOL
Title or Position: PRESIDENT
Credential: MD
Phone: 340-715-7720