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General NPI Number Information
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NPI Number | 1457451403
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Entity Type | Organization
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Legal Business Name | QUALITY CARE DIALYSIS CENTER OF VEGA BAJA, INC.
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Dates
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Enumeration Date | 09/22/2006
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Last Update Date | 10/13/2023
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Provider Practice Location Address
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Address Line | RD PR 2 KM 39.5
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City | VEGA BAJA
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State | PR
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Zip | 00693-0000
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Country | US
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Telephone | 787-858-3355
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Fax | 787-855-2762
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Provider Business Mailing Address
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Address Line | RD PR 2 KM 39.5
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City | VEGA BAJA
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State | PR
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Zip | 00693-0000
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Country | US
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Telephone | 787-858-3355
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Fax | 787-855-2762
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Authorized Official
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Title or Position | VICE PRESIDENT
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Name | BARRY L. BLANTON
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Credential |
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Telephone | 781-699-9000
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QE0700X
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Taxonomy Name | End-Stage Renal Disease (ESRD) Treatment Clinic/Center
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License Number |
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License Number State |
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