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General NPI Number Information
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NPI Number | 1760694350
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Entity Type | Organization
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Legal Business Name | CENTRO DE VACUNACION DE TOA ALTA
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Dates
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Enumeration Date | 05/04/2007
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Last Update Date | 07/01/2008
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Provider Practice Location Address
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Address Line | 52 CALLE PALMER
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City | TOA ALTA
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State | PR
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Zip | 00953-2428
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Country | US
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Telephone | 787-870-7501
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Fax | 787-870-1324
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Provider Business Mailing Address
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Address Line | 52 CALLE PALMER
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City | TOA ALTA
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State | PR
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Zip | 00953-2428
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Country | US
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Telephone | 787-870-7501
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Fax | 787-870-1324
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Authorized Official
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Title or Position | PROPIETARIO
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Name | DR. IVAN A CEREZO
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Credential | MD
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Telephone | 787-870-7501
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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 | 9816
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License Number State | PR
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