Provider Demographics
NPI:1114123320
Name:POLICLINICA FAMILIAR VEGA BAJA
Entity Type:Organization
Organization Name:POLICLINICA FAMILIAR VEGA BAJA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSE E
Authorized Official - Middle Name:COLON
Authorized Official - Last Name:RIVERA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-858-7073
Mailing Address - Street 1:U23 CALLE 7
Mailing Address - Street 2:ROSARIO II
Mailing Address - City:VEGA BAJA
Mailing Address - State:PR
Mailing Address - Zip Code:00693-5702
Mailing Address - Country:US
Mailing Address - Phone:787-858-7073
Mailing Address - Fax:787-807-1090
Practice Address - Street 1:AVENIDA TRIO VEGABAJENO
Practice Address - Street 2:U23 URB EL ROSARIO II
Practice Address - City:VEGA BAJA
Practice Address - State:PR
Practice Address - Zip Code:00693
Practice Address - Country:US
Practice Address - Phone:787-858-7073
Practice Address - Fax:787-807-1090
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-25
Last Update Date:2008-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty