Provider Demographics
NPI:1154858561
Name:CENTRO RYDER SAN LORENZO VACUNACION
Entity Type:Organization
Organization Name:CENTRO RYDER SAN LORENZO VACUNACION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXCUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSE
Authorized Official - Middle Name:R
Authorized Official - Last Name:FELICIANO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-852-0882
Mailing Address - Street 1:MUNOZ RIVERA FINAL
Mailing Address - Street 2:
Mailing Address - City:SAN LORENZO
Mailing Address - State:PR
Mailing Address - Zip Code:00754
Mailing Address - Country:US
Mailing Address - Phone:787-852-0882
Mailing Address - Fax:787-852-0157
Practice Address - Street 1:CARR 181 KM 1 H 0
Practice Address - Street 2:CALLE MUNOZ RIVERA FINAL
Practice Address - City:SAN LORENZO
Practice Address - State:PR
Practice Address - Zip Code:00754
Practice Address - Country:US
Practice Address - Phone:787-852-0882
Practice Address - Fax:787-852-0157
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CENTRO RYDER SAN LORENZO
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-05-16
Last Update Date:2017-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR78261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center