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General NPI Number Information
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NPI Number | 1063771251
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Entity Type | Organization
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Legal Business Name | VITAL INC. CLINICA DE SALUD
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Dates
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Enumeration Date | 05/09/2012
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Last Update Date | 05/09/2012
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Provider Practice Location Address
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Address Line | CAGUAS NORTE G 6 CALLE FLORENCIA
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City | CAGUAS
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State | PR
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Zip | 00725
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Country | US
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Telephone | 787-258-5681
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Fax | 787-258-5681
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Provider Business Mailing Address
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Address Line | CAGUAS NORTE ST. FLORENCIA G 6
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City | CAGUAS
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State | PR
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Zip | 00725
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Country | US
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Telephone | 787-258-5681
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Fax | 787-258-5681
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Authorized Official
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Title or Position | M.D.
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Name | MRS. BETANIA REYES MATOS
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Credential | 16154
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Telephone | 787-258-5681
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number | 660749610
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License Number State | PR
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