Provider Demographics
NPI:1649477019
Name:CENTRO DE VACUNACION MUNICIPAL
Entity type:Organization
Organization Name:CENTRO DE VACUNACION MUNICIPAL
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JULIO
Authorized Official - Middle Name:ANIBAL
Authorized Official - Last Name:BACO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-849-4059
Mailing Address - Street 1:P.O. BOX 97
Mailing Address - Street 2:
Mailing Address - City:HORMIGUEROS
Mailing Address - State:PR
Mailing Address - Zip Code:00660
Mailing Address - Country:US
Mailing Address - Phone:787-849-4059
Mailing Address - Fax:787-849-4058
Practice Address - Street 1:ST. 345 KM 1.2
Practice Address - Street 2:COMPLEJO DEPORTIVO MELANIO BOBE
Practice Address - City:HORMIGUEROS
Practice Address - State:PR
Practice Address - Zip Code:00660
Practice Address - Country:US
Practice Address - Phone:787-849-4059
Practice Address - Fax:787-849-4058
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-29
Last Update Date:2008-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR608507175L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes175L00000XOther Service ProvidersHomeopathGroup - Single Specialty