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General NPI Number Information
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NPI Number | 1851777817
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Entity Type | Organization
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Legal Business Name | NEW VERSION WELLNESS CLINIC
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Dates
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Enumeration Date | 07/31/2015
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Last Update Date | 08/26/2015
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Provider Practice Location Address
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Address Line | 572 CALLE CESAR GONZALEZ
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City | HATO REY
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State | PR
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Zip | 00919-0000
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Country | US
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Telephone | 954-998-8611
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Fax | 787-686-6048
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Provider Business Mailing Address
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Address Line | 572 CALLE CESAR GONZALEZ
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City | HATO REY
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State | PR
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Zip | 00919
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Country | US
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Telephone | 954-998-8611
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. LILLIAN J VARGAS BERNIER
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Credential |
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Telephone | 954-998-8611
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2083T0002X
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Taxonomy Name | Medical Toxicology (Preventive Medicine) Physician
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License Number | 18973
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License Number State | PR
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