Provider Demographics
NPI:1093234544
Name:CENTRO TERAPEUTICO GLORIMAR VEGA INC.
Entity Type:Organization
Organization Name:CENTRO TERAPEUTICO GLORIMAR VEGA INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GLORIMAR
Authorized Official - Middle Name:
Authorized Official - Last Name:VEGA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-378-9807
Mailing Address - Street 1:HC 5 BOX 30395
Mailing Address - Street 2:
Mailing Address - City:CAMUY
Mailing Address - State:PR
Mailing Address - Zip Code:00627-9581
Mailing Address - Country:US
Mailing Address - Phone:787-378-9807
Mailing Address - Fax:787-680-1200
Practice Address - Street 1:CARR 2 INTERIOR KIL 92.3
Practice Address - Street 2:BARRIO PUENTE PENA
Practice Address - City:CAMUY
Practice Address - State:PR
Practice Address - Zip Code:00627
Practice Address - Country:US
Practice Address - Phone:787-680-1200
Practice Address - Fax:787-680-1200
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-09-15
Last Update Date:2020-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center