Provider Demographics
NPI:1942613047
Name:VITALIDAD WELLNESS CENTER CSP
Entity Type:Organization
Organization Name:VITALIDAD WELLNESS CENTER CSP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENTE
Authorized Official - Prefix:DR
Authorized Official - First Name:ALEJANDRO
Authorized Official - Middle Name:
Authorized Official - Last Name:OSUNA PEREZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-961-3809
Mailing Address - Street 1:HC 4 BOX 44292
Mailing Address - Street 2:BO TURABO
Mailing Address - City:CAGUAS
Mailing Address - State:PR
Mailing Address - Zip Code:00727-9605
Mailing Address - Country:US
Mailing Address - Phone:787-961-3809
Mailing Address - Fax:787-961-3810
Practice Address - Street 1:CARR 1 KM 33.3 AVE ANGORA BAIROA LOCAL 3
Practice Address - Street 2:CENTRO COMERCIAL RALPHS FOOD WAREHOUSE
Practice Address - City:CAGUAS
Practice Address - State:PR
Practice Address - Zip Code:00725
Practice Address - Country:US
Practice Address - Phone:787-961-3809
Practice Address - Fax:787-961-3810
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-05
Last Update Date:2014-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty