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General NPI Number Information
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NPI Number | 1417345612
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Entity Type | Organization
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Legal Business Name | CENTRO VACUNIN
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Dates
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Enumeration Date | 12/23/2014
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Last Update Date | 12/23/2014
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Provider Practice Location Address
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Address Line | 161 CALLE CESAR GONZALEZ APDO 17 PAVILION COURT
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City | SAN JUAN
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State | PR
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Zip | 00917
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Country | US
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Telephone | 787-604-2468
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Fax |
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Provider Business Mailing Address
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Address Line | 161 CALLE CESAR GONZALEZ APDO 17 PAVILION COURT
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City | SAN JUAN
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State | PR
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Zip | 00917
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | JUAN TORRES
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Credential |
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Telephone | 787-604-2468
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | 71826
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License Number State | PR
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