MEDICARE: CENTRO DE VACUNACION DE CATANO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261Q00000X	Clinic/Center	9816	PR

General Provider Information

NPI Number	:	1962614842
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CENTRO DE VACUNACION DE CATANO

Provider Business Mailing Address
First Line	:	CALLE BARBOSA ESQ SAN LORENZO NUMERO 63
Second Line	:
City	:	CATANO
State	:	PR
Zip	:	00963
Country	:	US
Telephone Number	:	787-788-4567
Fax Number	:	787-870-1324

Provider Business Practice Location Address
First Line	:	CALLE BARBOSA
Second Line	:	ESQ SAN LORENZO 63
City	:	CATANO
State	:	PR
Zip	:	00963
Country	:	US
Telephone Number	:	787-788-4567
Fax Number	:	787-870-1324

Authorized Official
Title or Position	:	PROPIETARIO
Name	:	DR. IVAN A CEREZO
Credential	:	M.D.
Telephone Number	:	787-287-7973

Provider Enumeration Date	:	05/04/2007
Last Update Date	:	08/07/2008

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Directions to “CENTRO DE VACUNACION DE CATANO ” Practice Location

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