1144785841 NPI number — VPS MEDICAL GROUP LLC

Table of content: (NPI 1144785841)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1144785841 NPI number — VPS MEDICAL GROUP LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
VPS MEDICAL GROUP LLC
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:
1144785841
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/07/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1341 CALLE ALDEA APT TH5
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAN JUAN
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00907-2321
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-590-8584
Provider Business Mailing Address Fax Number:
787-254-9573

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1396 CALLE SAN RAFAEL
Provider Second Line Business Practice Location Address:
MEDICAL PAVILION SUITE 15
Provider Business Practice Location Address City Name:
SAN JUAN
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00909
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-590-8584
Provider Business Practice Location Address Fax Number:
939-715-1061
Provider Enumeration Date:
02/06/2019

Additional Information

Authorized Official

Authorized Official Last Name:
VALDIVIESO RODRIGUEZ
Authorized Official First Name:
ALFRED
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
787-590-8584

Provider Taxonomy Codes

  • Taxonomy code: 207P00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 421650 . This is a "REGISTER NUMBER" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com