Provider Demographics
NPI:1063771251
Name:VITAL INC. CLINICA DE SALUD
Entity type:Organization
Organization Name:VITAL INC. CLINICA DE SALUD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:M.D.
Authorized Official - Prefix:MRS
Authorized Official - First Name:BETANIA
Authorized Official - Middle Name:
Authorized Official - Last Name:REYES MATOS
Authorized Official - Suffix:
Authorized Official - Credentials:16154
Authorized Official - Phone:787-258-5681
Mailing Address - Street 1:CAGUAS NORTE
Mailing Address - Street 2:ST. FLORENCIA G 6
Mailing Address - City:CAGUAS
Mailing Address - State:PR
Mailing Address - Zip Code:00725
Mailing Address - Country:US
Mailing Address - Phone:787-258-5681
Mailing Address - Fax:787-258-5681
Practice Address - Street 1:CAGUAS NORTE
Practice Address - Street 2:G 6 CALLE FLORENCIA
Practice Address - City:CAGUAS
Practice Address - State:PR
Practice Address - Zip Code:00725
Practice Address - Country:US
Practice Address - Phone:787-258-5681
Practice Address - Fax:787-258-5681
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-09
Last Update Date:2012-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR660749610261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service