Provider Demographics
NPI:1124231246
Name:IPA POLICLINICA VILLA LOS SANTOS
Entity Type:Organization
Organization Name:IPA POLICLINICA VILLA LOS SANTOS
Other - Org Name:CENTRO VACUNACION IPA29
Other - Org Type:Other Name
Authorized Official - Title/Position:SUPERVISOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:CARMEN
Authorized Official - Middle Name:MELENDEZ
Authorized Official - Last Name:ACEVEDO
Authorized Official - Suffix:
Authorized Official - Credentials:REGISTER NURSE
Authorized Official - Phone:787-879-1585
Mailing Address - Street 1:URB. VILLA LOS SANTOS
Mailing Address - Street 2:CALLE 16 V-1
Mailing Address - City:ARECIBO
Mailing Address - State:PR
Mailing Address - Zip Code:00612
Mailing Address - Country:US
Mailing Address - Phone:787-879-1585
Mailing Address - Fax:787-879-4315
Practice Address - Street 1:URB. VILLA LOS SANTOS
Practice Address - Street 2:CALLE 16 V-1
Practice Address - City:ARECIBO
Practice Address - State:PR
Practice Address - Zip Code:00612
Practice Address - Country:US
Practice Address - Phone:787-879-1585
Practice Address - Fax:787-879-4315
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-07
Last Update Date:2008-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR66051521737OtherTAX ID