1255757084 NPI number — CENTRO DE VACUNACION BORINQUEN

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1255757084 NPI number — CENTRO DE VACUNACION BORINQUEN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CENTRO DE VACUNACION BORINQUEN
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1255757084
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/18/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 4319
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
AGUADILLA
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00605-4319
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-819-3829
Provider Business Mailing Address Fax Number:
787-819-3829

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
CARR. 107 KM 1.1
Provider Second Line Business Practice Location Address:
BO. BORINQUEN
Provider Business Practice Location Address City Name:
AGUADILLA
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00603
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-819-3829
Provider Business Practice Location Address Fax Number:
787-819-3829
Provider Enumeration Date:
03/18/2014

Additional Information

Authorized Official

Authorized Official Last Name:
GARCIA
Authorized Official First Name:
ALEYDA
Authorized Official Middle Name:
IVETTE
Authorized Official Title or Position:
ADMINISTRATOR
Authorized Official Telephone Number:
787-819-3829

Provider Taxonomy Codes

  • Taxonomy code: 261Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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