Provider Demographics
NPI:1891954632
Name:MAYAGUEZ INFUSION CENTER CORP
Entity Type:Organization
Organization Name:MAYAGUEZ INFUSION CENTER CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:SUSANA
Authorized Official - Middle Name:
Authorized Official - Last Name:VARGAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-633-5840
Mailing Address - Street 1:CARR 165 TORRE 1 ST 305
Mailing Address - Street 2:CENTRO INTERNACIONAL DE MERCADEO
Mailing Address - City:GUAYNABO
Mailing Address - State:PR
Mailing Address - Zip Code:00968-0000
Mailing Address - Country:US
Mailing Address - Phone:787-633-5840
Mailing Address - Fax:787-792-7500
Practice Address - Street 1:CALLE DE LA CANDELARIA #12 OESTE
Practice Address - Street 2:
Practice Address - City:MAYAGUEZ
Practice Address - State:PR
Practice Address - Zip Code:00680
Practice Address - Country:US
Practice Address - Phone:787-986-1012
Practice Address - Fax:787-806-1011
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-06
Last Update Date:2008-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR10B4135261QI0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QI0500XAmbulatory Health Care FacilitiesClinic/CenterInfusion Therapy