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General NPI Number Information
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NPI Number | 1780967786
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Entity Type | Organization
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Legal Business Name | ADVANCE VACCINE CENTER
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Dates
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Enumeration Date | 09/26/2011
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Last Update Date | 09/26/2011
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Provider Practice Location Address
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Address Line | URB PRADERAS DE NAVARRO, 341 CALLE SERPENTINA
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City | GURABO
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State | PR
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Zip | 00778-9078
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Country | US
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Telephone | 787-430-9979
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Fax |
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Provider Business Mailing Address
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Address Line | URB PRADERAS DE NAVARRO, 341 CALLE SERPENTINA
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City | GURABO
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State | PR
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Zip | 00778-9078
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Country | US
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Telephone | 787-430-9979
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | ANTONIO IGLESIAS
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Credential |
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Telephone | 787-430-9979
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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 | 303521
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License Number State | PR
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