Provider Demographics
NPI:1083281927
Name:VACCINES 360 LLC
Entity Type:Organization
Organization Name:VACCINES 360 LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE-PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:WILFREDO
Authorized Official - Middle Name:J
Authorized Official - Last Name:PEREZ VARGAS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-362-9116
Mailing Address - Street 1:BRISAS DE LAUREL
Mailing Address - Street 2:420 DIAMANTE STREET
Mailing Address - City:COTO LAUREL
Mailing Address - State:PR
Mailing Address - Zip Code:00780
Mailing Address - Country:US
Mailing Address - Phone:787-362-9116
Mailing Address - Fax:787-260-6116
Practice Address - Street 1:BRISAS DE LAUREL
Practice Address - Street 2:420 DIAMANTE STREET
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00780-2217
Practice Address - Country:US
Practice Address - Phone:787-362-9116
Practice Address - Fax:787-260-6116
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-09
Last Update Date:2021-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care