=====================================================
General NPI Number Information
=====================================================
NPI Number | 1871713487
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CENTRO DE VACUNACION DE AGUADILLA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/26/2007
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | EDIFICIO HERNANDEZ STE # 1
-----------------------------------------------------
City | AGUADILLA
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00603
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-891-4851
-----------------------------------------------------
Fax | 787-891-4851
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 5080 STE. # 167
-----------------------------------------------------
City | AGUADILLA
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00605-5080
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OFFICE MANAGER
-----------------------------------------------------
Name | MRS. MIRIAM ACEVEDO
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 787-891-4851
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QH0100X
-----------------------------------------------------
Taxonomy Name | Health Service Clinic/Center
-----------------------------------------------------
License Number | 12658
-----------------------------------------------------
License Number State | PR
-----------------------------------------------------