Provider Demographics
NPI:1275872525
Name:CENTRO DE VACUNACION DR. HECTOR SANTIAGO
Entity Type:Organization
Organization Name:CENTRO DE VACUNACION DR. HECTOR SANTIAGO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:VELIA
Authorized Official - Middle Name:
Authorized Official - Last Name:MARTINEZ DE SANTIAGO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-796-1719
Mailing Address - Street 1:PO BOX 68
Mailing Address - Street 2:
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00960-0068
Mailing Address - Country:US
Mailing Address - Phone:787-796-1719
Mailing Address - Fax:
Practice Address - Street 1:321 CALLE MENDEZ VIGO
Practice Address - Street 2:
Practice Address - City:DORADO
Practice Address - State:PR
Practice Address - Zip Code:00646-4929
Practice Address - Country:US
Practice Address - Phone:787-796-1719
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-06
Last Update Date:2013-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR3155261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center