Provider Demographics
NPI:1336589126
Name:VALS HOLISTIC WELLNESS LLC
Entity Type:Organization
Organization Name:VALS HOLISTIC WELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:WENCY
Authorized Official - Middle Name:
Authorized Official - Last Name:RUBIO GONZALEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-725-4945
Mailing Address - Street 1:ASHFORD MEDICAL CTR
Mailing Address - Street 2:29 WASHINGTON STREET SUITE 102
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00907-1510
Mailing Address - Country:US
Mailing Address - Phone:787-725-4945
Mailing Address - Fax:787-725-0623
Practice Address - Street 1:ASHFORD MEDICAL CTR
Practice Address - Street 2:29 WASHINGTON STREET SUITE 102
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00907-1510
Practice Address - Country:US
Practice Address - Phone:787-725-4945
Practice Address - Fax:787-725-0623
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-26
Last Update Date:2015-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR12616207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty