Provider Demographics
NPI:1811213218
Name:CENTRO DE VACUNACION CALLE LOIZA DR CEREZO
Entity type:Organization
Organization Name:CENTRO DE VACUNACION CALLE LOIZA DR CEREZO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:IVAN
Authorized Official - Middle Name:
Authorized Official - Last Name:CEREZO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-727-8833
Mailing Address - Street 1:52 CALLE PALMER
Mailing Address - Street 2:
Mailing Address - City:TOA ALTA
Mailing Address - State:PR
Mailing Address - Zip Code:00953-2428
Mailing Address - Country:US
Mailing Address - Phone:787-727-8833
Mailing Address - Fax:787-727-8833
Practice Address - Street 1:1915, LOIZA STREET
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00911-1888
Practice Address - Country:US
Practice Address - Phone:787-727-8833
Practice Address - Fax:787-727-8833
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-12
Last Update Date:2010-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center