Provider Demographics
NPI:1578265435
Name:ISLA VERDE HEALTH AND WELLNESS CORP.
Entity Type:Organization
Organization Name:ISLA VERDE HEALTH AND WELLNESS CORP.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ANGEL
Authorized Official - Middle Name:C
Authorized Official - Last Name:REYES VARGAS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-223-4504
Mailing Address - Street 1:PO BOX 424
Mailing Address - Street 2:
Mailing Address - City:AGUIRRE
Mailing Address - State:PR
Mailing Address - Zip Code:00704-0424
Mailing Address - Country:US
Mailing Address - Phone:787-223-4504
Mailing Address - Fax:
Practice Address - Street 1:6150 AVE ISLA VERDE STE 12
Practice Address - Street 2:
Practice Address - City:CAROLINA
Practice Address - State:PR
Practice Address - Zip Code:00979-5744
Practice Address - Country:US
Practice Address - Phone:787-223-4504
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-03-21
Last Update Date:2023-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty