Provider Demographics
NPI:1255879474
Name:CENTRO DE VACUNACION Y SERVIVIOS INTEGRADOS DE SALUD,INC.
Entity type:Organization
Organization Name:CENTRO DE VACUNACION Y SERVIVIOS INTEGRADOS DE SALUD,INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ADOLFO
Authorized Official - Middle Name:
Authorized Official - Last Name:MATIAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-229-1110
Mailing Address - Street 1:RR 2 BOX 2725
Mailing Address - Street 2:
Mailing Address - City:ANASCO
Mailing Address - State:PR
Mailing Address - Zip Code:00610-9602
Mailing Address - Country:US
Mailing Address - Phone:787-229-1110
Mailing Address - Fax:787-229-1110
Practice Address - Street 1:CARRETERA 402 4.6KM
Practice Address - Street 2:BOX PINALES
Practice Address - City:ANASCO
Practice Address - State:PR
Practice Address - Zip Code:00610
Practice Address - Country:US
Practice Address - Phone:787-229-1110
Practice Address - Fax:787-229-1110
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-08
Last Update Date:2017-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR14771261QP2300X
PR029804261QM1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care