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General NPI Number Information
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NPI Number | 1891916060
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Entity Type | Organization
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Legal Business Name | CENTRO DE VACUNACION DE GUAYNABO
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Dates
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Enumeration Date | 05/02/2007
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Last Update Date | 08/07/2008
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Provider Practice Location Address
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Address Line | 70 CALLE CARAZO GUAYNABO PUEBLO
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City | GUAYNABO
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State | PR
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Zip | 00969-5606
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Country | US
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Telephone | 787-287-7973
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Fax | 787-287-7973
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Provider Business Mailing Address
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Address Line | 70 CALLE CARAZO
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City | GUAYNABO
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State | PR
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Zip | 00969-5606
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Country | US
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Telephone | 787-287-7973
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Fax | 787-287-7973
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Authorized Official
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Title or Position | PROPIETEARIO
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Name | DR. IVAN A CEREZO
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Credential | M.D.
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Telephone | 787-287-7973
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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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