Provider Demographics
NPI:1336414036
Name:CERVAC
Entity Type:Organization
Organization Name:CERVAC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FORENSIC AND ANATOMICAL PATHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:YOCASTA
Authorized Official - Middle Name:
Authorized Official - Last Name:BRUGAL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-790-7525
Mailing Address - Street 1:138 AVE WINSTON CHURCHILL
Mailing Address - Street 2:MSC 932
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00926-6013
Mailing Address - Country:US
Mailing Address - Phone:787-790-7525
Mailing Address - Fax:787-790-7525
Practice Address - Street 1:43 AVE ESMERALDA
Practice Address - Street 2:LOCAL B - INTERIOR
Practice Address - City:GUAYNABO
Practice Address - State:PR
Practice Address - Zip Code:00969-4430
Practice Address - Country:US
Practice Address - Phone:787-790-7525
Practice Address - Fax:787-790-7525
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-13
Last Update Date:2012-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR4820174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty