Provider Demographics
NPI:1730125584
Name:VEGA ALTA COMMUNITY HEALTH
Entity Type:Organization
Organization Name:VEGA ALTA COMMUNITY HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR MEDICO
Authorized Official - Prefix:DR
Authorized Official - First Name:LUIS
Authorized Official - Middle Name:M
Authorized Official - Last Name:GONZALEZ BERMUDEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-278-3331
Mailing Address - Street 1:PO BOX 419
Mailing Address - Street 2:
Mailing Address - City:VEGA ALTA
Mailing Address - State:PR
Mailing Address - Zip Code:00692
Mailing Address - Country:US
Mailing Address - Phone:787-270-2300
Mailing Address - Fax:787-278-3331
Practice Address - Street 1:#2 STREET KM 30.1
Practice Address - Street 2:BO BAJURAS
Practice Address - City:VEGA ALTA
Practice Address - State:PR
Practice Address - Zip Code:00692
Practice Address - Country:US
Practice Address - Phone:787-270-2300
Practice Address - Fax:787-278-3331
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0002XAmbulatory Health Care FacilitiesClinic/CenterEmergency Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR0083936Medicare ID - Type UnspecifiedGRUPO MEDICO