Provider Demographics
NPI:1689267213
Name:VACUVIDA LLC
Entity Type:Organization
Organization Name:VACUVIDA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:H
Authorized Official - Last Name:QUIRINDONGO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-543-1482
Mailing Address - Street 1:URB HACIENDA FLORIDA CALLE JAZMIN #695
Mailing Address - Street 2:
Mailing Address - City:YAUCO
Mailing Address - State:PR
Mailing Address - Zip Code:00698
Mailing Address - Country:US
Mailing Address - Phone:787-237-8623
Mailing Address - Fax:
Practice Address - Street 1:C&C PROFESIONAL PLAZA
Practice Address - Street 2:CARR 335 KM 1.5 LOCAL 3
Practice Address - City:YAUCO
Practice Address - State:PR
Practice Address - Zip Code:00698
Practice Address - Country:US
Practice Address - Phone:787-543-1482
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-02-15
Last Update Date:2021-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
No261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No261QI0500XAmbulatory Health Care FacilitiesClinic/CenterInfusion Therapy
No261QP0905XAmbulatory Health Care FacilitiesClinic/CenterPublic Health, State or Local