Provider Demographics
NPI:1912450735
Name:DEPARTAMENTO DE SALUD OFICIAL
Entity Type:Organization
Organization Name:DEPARTAMENTO DE SALUD OFICIAL
Other - Org Name:CENTRO DE VACUNACION ESTEBAN CALDERON
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTORS
Authorized Official - Prefix:MR
Authorized Official - First Name:PRUDENCIO
Authorized Official - Middle Name:A
Authorized Official - Last Name:LAUREANO
Authorized Official - Suffix:SR
Authorized Official - Credentials:
Authorized Official - Phone:787-787-5151
Mailing Address - Street 1:100 AVE LAUREL
Mailing Address - Street 2:SANTA JUANITA
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00956
Mailing Address - Country:US
Mailing Address - Phone:787-787-5151
Mailing Address - Fax:787-786-6165
Practice Address - Street 1:100 AVE LAUREL
Practice Address - Street 2:SANTA JUANITA
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00956-4816
Practice Address - Country:US
Practice Address - Phone:787-787-5151
Practice Address - Fax:787-786-6165
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-28
Last Update Date:2016-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR400105Medicare PIN