Provider Demographics
NPI:1003678830
Name:CENTRO DE VACUNACION DE LA POLICLINICA DE ANASCO
Entity Type:Organization
Organization Name:CENTRO DE VACUNACION DE LA POLICLINICA DE ANASCO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESWIDENTE
Authorized Official - Prefix:
Authorized Official - First Name:ROBERTO
Authorized Official - Middle Name:J
Authorized Official - Last Name:AYALA RIOS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-370-6187
Mailing Address - Street 1:PO BOX 1750
Mailing Address - Street 2:
Mailing Address - City:ANASCO
Mailing Address - State:PR
Mailing Address - Zip Code:00610-1750
Mailing Address - Country:US
Mailing Address - Phone:787-826-2145
Mailing Address - Fax:787-826-7411
Practice Address - Street 1:65 DE INFANTERIA #67
Practice Address - Street 2:SUITE 104
Practice Address - City:ANASCO
Practice Address - State:PR
Practice Address - Zip Code:00610
Practice Address - Country:US
Practice Address - Phone:787-826-2145
Practice Address - Fax:787-826-7411
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-26
Last Update Date:2024-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2083P0901XAllopathic & Osteopathic PhysiciansPreventive MedicinePublic Health & General Preventive MedicineGroup - Single Specialty
No261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth ServiceGroup - Single Specialty