Provider Demographics
NPI:1073167771
Name:CLINICA VITALIZA CORP
Entity Type:Organization
Organization Name:CLINICA VITALIZA CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENTE
Authorized Official - Prefix:
Authorized Official - First Name:JOHARYS
Authorized Official - Middle Name:K
Authorized Official - Last Name:AYBAR CRUZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-627-9285
Mailing Address - Street 1:URB VILLA CAROLINA
Mailing Address - Street 2:141-15 CALLE 411
Mailing Address - City:CAROLINA
Mailing Address - State:PR
Mailing Address - Zip Code:00985
Mailing Address - Country:US
Mailing Address - Phone:787-627-9285
Mailing Address - Fax:
Practice Address - Street 1:CAROLINA SHOPPING COURT
Practice Address - Street 2:307A AVENIDA ROBERTO CLEMENTE
Practice Address - City:CAROLINA
Practice Address - State:PR
Practice Address - Zip Code:00985
Practice Address - Country:US
Practice Address - Phone:787-627-9285
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-07-31
Last Update Date:2019-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounselingGroup - Multi-Specialty
No261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-SpecialtyGroup - Multi-Specialty