Provider Demographics
NPI:1992847107
Name:CENTRO DE VACUNACION POLICLINICA DR. RADAMES MARIN, INC.
Entity Type:Organization
Organization Name:CENTRO DE VACUNACION POLICLINICA DR. RADAMES MARIN, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RADAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:MARIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-856-0844
Mailing Address - Street 1:PO BOX 1665
Mailing Address - Street 2:
Mailing Address - City:YAUCO
Mailing Address - State:PR
Mailing Address - Zip Code:00698-1665
Mailing Address - Country:US
Mailing Address - Phone:787-856-0844
Mailing Address - Fax:787-267-5554
Practice Address - Street 1:61 CALLE COMERCIO
Practice Address - Street 2:
Practice Address - City:YAUCO
Practice Address - State:PR
Practice Address - Zip Code:00698-3541
Practice Address - Country:US
Practice Address - Phone:787-856-0844
Practice Address - Fax:787-267-5554
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-13
Last Update Date:2015-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR10525OtherTRIPLE S