Provider Demographics
NPI:1669124046
Name:CENTRO DE VACUNACION INTER METRO
Entity type:Organization
Organization Name:CENTRO DE VACUNACION INTER METRO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:RECTORA
Authorized Official - Prefix:
Authorized Official - First Name:MARILINA
Authorized Official - Middle Name:L
Authorized Official - Last Name:WAYLAND
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-250-1912
Mailing Address - Street 1:PO BOX 191293
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00919-1293
Mailing Address - Country:US
Mailing Address - Phone:787-250-1912
Mailing Address - Fax:
Practice Address - Street 1:100 CALLE FRANCISCO SEIN
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00926-5104
Practice Address - Country:US
Practice Address - Phone:787-250-1912
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:INTER AMERICAN UNIVERSITY OF PUERTO RICO
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-01-26
Last Update Date:2022-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center