Provider Demographics
NPI:1396489126
Name:CENTRO DE SERVICIOS DE SALUD VILLA NEVAREZ LLC
Entity type:Organization
Organization Name:CENTRO DE SERVICIOS DE SALUD VILLA NEVAREZ LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:WALESKA
Authorized Official - Middle Name:
Authorized Official - Last Name:NUNEZ SANTIAGO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-810-3434
Mailing Address - Street 1:1111 CALLE 1
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00927-5134
Mailing Address - Country:US
Mailing Address - Phone:787-810-3434
Mailing Address - Fax:888-351-4227
Practice Address - Street 1:1111 CALLE 1
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00927-5134
Practice Address - Country:US
Practice Address - Phone:787-810-3434
Practice Address - Fax:888-351-4227
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-04-27
Last Update Date:2022-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR16203OtherSTATE LICENSE