1942613047 NPI number — VITALIDAD WELLNESS CENTER CSP

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 1942613047 NPI number — VITALIDAD WELLNESS CENTER CSP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
VITALIDAD WELLNESS CENTER CSP
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:
1942613047
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/05/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
HC 4 BOX 44292
Provider Second Line Business Mailing Address:
BO TURABO
Provider Business Mailing Address City Name:
CAGUAS
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00727-9605
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-961-3809
Provider Business Mailing Address Fax Number:
787-961-3810

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
CARR 1 KM 33.3 AVE ANGORA BAIROA LOCAL 3
Provider Second Line Business Practice Location Address:
CENTRO COMERCIAL RALPHS FOOD WAREHOUSE
Provider Business Practice Location Address City Name:
CAGUAS
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00725
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-961-3809
Provider Business Practice Location Address Fax Number:
787-961-3810
Provider Enumeration Date:
06/05/2014

Additional Information

Authorized Official

Authorized Official Last Name:
OSUNA PEREZ
Authorized Official First Name:
ALEJANDRO
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENTE
Authorized Official Telephone Number:
787-961-3809

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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