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General NPI Number Information
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NPI Number | 1649659756
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Entity Type | Organization
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Legal Business Name | PUERTO RICO VASCULAR ACCESS CENTER PSC
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Dates
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Enumeration Date | 05/21/2015
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Last Update Date | 10/29/2019
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Provider Practice Location Address
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Address Line | AVE PONCE DE LEON PDA 37 1/2 HOSP AUXILIO MUTUO 1ST FL
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City | SAN JUAN
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State | PR
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Zip | 00918-1227
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Country | US
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Telephone | 787-758-3320
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Fax | 787-758-3358
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Provider Business Mailing Address
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Address Line | PO BOX 361275
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City | SAN JUAN
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State | PR
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Zip | 00936-1275
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Country | US
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Telephone | 787-758-3320
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Fax | 787-758-3358
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. CARLOS G RIVERA
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Credential | M.D.
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Telephone | 787-361-0012
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085R0204X
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Taxonomy Name | Vascular & Interventional Radiology Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207RN0300X
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Taxonomy Name | Nephrology Physician
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License Number |
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License Number State |
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