Provider Demographics
NPI:1508035155
Name:DEPARTMENT OF VETERANS AFFAIRS
Entity Type:Organization
Organization Name:DEPARTMENT OF VETERANS AFFAIRS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LPN
Authorized Official - Prefix:MRS
Authorized Official - First Name:YARITZA
Authorized Official - Middle Name:
Authorized Official - Last Name:GONZALEZ-COLON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-368-8596
Mailing Address - Street 1:PO BOX 10000
Mailing Address - Street 2:PMB 147
Mailing Address - City:CANOVANAS
Mailing Address - State:PR
Mailing Address - Zip Code:00729-0011
Mailing Address - Country:US
Mailing Address - Phone:787-368-8596
Mailing Address - Fax:
Practice Address - Street 1:BO. LOMAS
Practice Address - Street 2:CARR 186 KM 4 HM 0
Practice Address - City:CANOVANAS
Practice Address - State:PR
Practice Address - Zip Code:00729-9782
Practice Address - Country:US
Practice Address - Phone:787-368-8596
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-28
Last Update Date:2008-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR4304979313M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility