=====================================================
General NPI Number Information
=====================================================
NPI Number | 1801408489
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | VACCINES & VITAMINS WELLNESS CENTER
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/17/2020
-----------------------------------------------------
Last Update Date | 08/20/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 293 AVE WINSTON CHURCHILL
-----------------------------------------------------
City | SAN JUAN
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00926-6604
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-944-5632
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 936 DOLORES P MARCHAND URB VILLAS DE RIO CANAS
-----------------------------------------------------
City | PONCE
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00728-1928
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-944-5632
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | ADMINISTRADORA
-----------------------------------------------------
Name | DANIA L COLON ALVARADO
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 787-432-7090
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261Q00000X
-----------------------------------------------------
Taxonomy Name | Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------