Provider Demographics
NPI:1841698586
Name:VACUNAS MED LLC
Entity type:Organization
Organization Name:VACUNAS MED LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JUAN
Authorized Official - Middle Name:GABRIEL
Authorized Official - Last Name:REYES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-549-8291
Mailing Address - Street 1:CARR 2 KM 47.8
Mailing Address - Street 2:
Mailing Address - City:MANATI
Mailing Address - State:PUERTO RICO
Mailing Address - Zip Code:00674
Mailing Address - Country:UM
Mailing Address - Phone:787-549-8291
Mailing Address - Fax:
Practice Address - Street 1:CARR 2 KM 47.8
Practice Address - Street 2:
Practice Address - City:MANATI
Practice Address - State:PUERTO RICO
Practice Address - Zip Code:00674
Practice Address - Country:UM
Practice Address - Phone:787-549-8291
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-11
Last Update Date:2014-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center