Provider Demographics
NPI:1275887473
Name:CLINICA VACUNACION Y MEDICA
Entity Type:Organization
Organization Name:CLINICA VACUNACION Y MEDICA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING SUPERVISOR
Authorized Official - Prefix:
Authorized Official - First Name:LISSETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:VAZQUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-535-1001
Mailing Address - Street 1:PO BOX 372800
Mailing Address - Street 2:
Mailing Address - City:CAYEY
Mailing Address - State:PR
Mailing Address - Zip Code:00737-2800
Mailing Address - Country:US
Mailing Address - Phone:787-535-1001
Mailing Address - Fax:787-535-1021
Practice Address - Street 1:A2 CALLE DR TROYER
Practice Address - Street 2:
Practice Address - City:AIBONITO
Practice Address - State:PR
Practice Address - Zip Code:00705-3304
Practice Address - Country:US
Practice Address - Phone:787-535-1001
Practice Address - Fax:787-535-1021
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MENNONITE GENERAL HOSPITAL INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-11-09
Last Update Date:2012-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR400018Medicare PIN