Provider Demographics
NPI:1114104569
Name:CENTRO DE VACUNACION DEL OESTE
Entity Type:Organization
Organization Name:CENTRO DE VACUNACION DEL OESTE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENTA-ADMINISTRADORA
Authorized Official - Prefix:MRS
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:SOTO
Authorized Official - Last Name:LORENZO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-313-4242
Mailing Address - Street 1:PO BOX 740
Mailing Address - Street 2:
Mailing Address - City:ANASCO
Mailing Address - State:PR
Mailing Address - Zip Code:00610-0740
Mailing Address - Country:US
Mailing Address - Phone:787-313-4242
Mailing Address - Fax:787-826-9700
Practice Address - Street 1:CARRETERA 107 VICTORIA
Practice Address - Street 2:
Practice Address - City:ANASCO
Practice Address - State:PR
Practice Address - Zip Code:00610-0740
Practice Address - Country:US
Practice Address - Phone:787-313-4242
Practice Address - Fax:787-826-9700
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-29
Last Update Date:2008-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center