Provider Demographics
NPI:1902210800
Name:AGUADILLA MEDICAL SERVICES, INC
Entity Type:Organization
Organization Name:AGUADILLA MEDICAL SERVICES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:MEICY
Authorized Official - Middle Name:Y
Authorized Official - Last Name:VARGAS
Authorized Official - Suffix:
Authorized Official - Credentials:LCDA
Authorized Official - Phone:787-882-0303
Mailing Address - Street 1:PO BOX 250479
Mailing Address - Street 2:BO. VICTORIA
Mailing Address - City:AGUADILLA
Mailing Address - State:PR
Mailing Address - Zip Code:00605-5265
Mailing Address - Country:US
Mailing Address - Phone:787-882-0303
Mailing Address - Fax:787-882-0399
Practice Address - Street 1:ROAD #2 KM 129.3
Practice Address - Street 2:VICTORIA AVENUE
Practice Address - City:AGUADILLA
Practice Address - State:PR
Practice Address - Zip Code:00604-5265
Practice Address - Country:US
Practice Address - Phone:787-882-0303
Practice Address - Fax:787-882-0399
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-18
Last Update Date:2014-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR22261QR0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR22OtherHEALTH DEPARTMENT