Provider Demographics
NPI:1316163843
Name:CENTRO DE VACUNACION DEL NOROESTE, INC.
Entity type:Organization
Organization Name:CENTRO DE VACUNACION DEL NOROESTE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENTE
Authorized Official - Prefix:MR
Authorized Official - First Name:FUAD
Authorized Official - Middle Name:S
Authorized Official - Last Name:ALBA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-736-7539
Mailing Address - Street 1:PO BOX 7003
Mailing Address - Street 2:CAGUAS
Mailing Address - City:CAGUAS
Mailing Address - State:PR
Mailing Address - Zip Code:00726-7003
Mailing Address - Country:US
Mailing Address - Phone:787-736-7539
Mailing Address - Fax:787-736-7539
Practice Address - Street 1:LIRIO F-3 BZN.27
Practice Address - Street 2:URB. VISTAS DE SAN LOENZO
Practice Address - City:SAN LORENZO
Practice Address - State:PR
Practice Address - Zip Code:00754
Practice Address - Country:US
Practice Address - Phone:787-736-7539
Practice Address - Fax:787-736-7539
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-17
Last Update Date:2008-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1134261QV0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QV0200XAmbulatory Health Care FacilitiesClinic/CenterVA