Provider Demographics
NPI:1578849600
Name:VCS MEDICAL SERVICES, LLC
Entity Type:Organization
Organization Name:VCS MEDICAL SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DOCTOR
Authorized Official - Prefix:
Authorized Official - First Name:VIRMARIE
Authorized Official - Middle Name:
Authorized Official - Last Name:CABAN SOTO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:939-644-1747
Mailing Address - Street 1:URBANIZACION PARAISO DE MAYAGUEZ
Mailing Address - Street 2:132
Mailing Address - City:MAYAGUEZ
Mailing Address - State:PR
Mailing Address - Zip Code:00680
Mailing Address - Country:US
Mailing Address - Phone:939-644-1747
Mailing Address - Fax:
Practice Address - Street 1:AVE 65 INFANTERIA
Practice Address - Street 2:90
Practice Address - City:ANASCO
Practice Address - State:PR
Practice Address - Zip Code:00610
Practice Address - Country:US
Practice Address - Phone:787-826-3565
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-03
Last Update Date:2011-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR14330208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRH80167Medicare UPIN