Provider Demographics
NPI:1922214626
Name:SERVICIOS DE SALUD PRIMARIOS DE BARCELONETA, INC. - VACUNACION
Entity Type:Organization
Organization Name:SERVICIOS DE SALUD PRIMARIOS DE BARCELONETA, INC. - VACUNACION
Other - Org Name:ATLANTIC MEDICAL CENTER - VACUNACION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:LEIDA
Authorized Official - Middle Name:A
Authorized Official - Last Name:NAZARIO
Authorized Official - Suffix:
Authorized Official - Credentials:MHSA
Authorized Official - Phone:787-846-4412
Mailing Address - Street 1:PO BOX 2045
Mailing Address - Street 2:CARR. #2, KM. 57.8, CRUCE DAVILA
Mailing Address - City:BARCELONETA
Mailing Address - State:PR
Mailing Address - Zip Code:00617-2045
Mailing Address - Country:US
Mailing Address - Phone:787-846-4412
Mailing Address - Fax:787-846-7410
Practice Address - Street 1:CARR. #2, KM. 57.8, CRUCE DAVILA
Practice Address - Street 2:
Practice Address - City:BARCELONETA
Practice Address - State:PR
Practice Address - Zip Code:00617-2045
Practice Address - Country:US
Practice Address - Phone:787-846-4412
Practice Address - Fax:787-846-7410
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-16
Last Update Date:2022-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center