Provider Demographics
NPI:1083472146
Name:ALBO, VANESSA
Entity Type:Individual
Prefix:
First Name:VANESSA
Middle Name:
Last Name:ALBO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:HC 70 BOX 30461
Mailing Address - Street 2:
Mailing Address - City:SAN LORENZO
Mailing Address - State:PR
Mailing Address - Zip Code:00754-9705
Mailing Address - Country:US
Mailing Address - Phone:787-639-6599
Mailing Address - Fax:
Practice Address - Street 1:AVENIDA PRINCIPAL MUNOZ RIVERA
Practice Address - Street 2:LOCAL # 150
Practice Address - City:SAN LORENZO
Practice Address - State:PR
Practice Address - Zip Code:00754-0000
Practice Address - Country:US
Practice Address - Phone:787-639-6599
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-12
Last Update Date:2024-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
156FX1800X
PR332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
No156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician