=====================================================
General NPI Number Information
=====================================================
NPI Number | 1477487148
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | EMUNA MEDICINE & AESTHETICS CLINIC LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/09/2026
-----------------------------------------------------
Last Update Date | 06/09/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 190 CALLE DR SUSONI
-----------------------------------------------------
City | HATILLO
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00659-2278
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 939-353-0970
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 418
-----------------------------------------------------
City | CAMUY
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00627-0418
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 939-353-0970
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. KEVIN O ALICEA VARGAS
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 787-612-0429
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208D00000X
-----------------------------------------------------
Taxonomy Name | General Practice Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 261Q00000X
-----------------------------------------------------
Taxonomy Name | Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------