Provider Demographics
NPI:1033418496
Name:NUEVA VIDA DE LA SALUD II
Entity Type:Organization
Organization Name:NUEVA VIDA DE LA SALUD II
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENTE
Authorized Official - Prefix:MR
Authorized Official - First Name:JORGE
Authorized Official - Middle Name:C
Authorized Official - Last Name:PRADO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-270-2686
Mailing Address - Street 1:PO BOX 468
Mailing Address - Street 2:
Mailing Address - City:VEGA BAJA
Mailing Address - State:PR
Mailing Address - Zip Code:00694-0468
Mailing Address - Country:US
Mailing Address - Phone:787-270-2686
Mailing Address - Fax:787-270-5292
Practice Address - Street 1:422 CALLE ITALIA
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00917-3625
Practice Address - Country:US
Practice Address - Phone:787-270-2686
Practice Address - Fax:787-270-5292
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-23
Last Update Date:2011-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation
No261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty