Provider Demographics
NPI:1346678711
Name:VACUNAS PLUS PONCE, INC
Entity Type:Organization
Organization Name:VACUNAS PLUS PONCE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:TAMARA
Authorized Official - Middle Name:
Authorized Official - Last Name:VALLS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-624-9994
Mailing Address - Street 1:PO BOX 3583
Mailing Address - Street 2:
Mailing Address - City:GUAYNABO
Mailing Address - State:PR
Mailing Address - Zip Code:00970-3583
Mailing Address - Country:US
Mailing Address - Phone:787-624-9994
Mailing Address - Fax:
Practice Address - Street 1:CALLE FERROCARRIL ESQUINA MARINA 9105
Practice Address - Street 2:SEGUNDO PISO EDIF ORENGO MEDICAL BUILDING
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00717
Practice Address - Country:US
Practice Address - Phone:787-624-9994
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-23
Last Update Date:2013-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center