Provider Demographics
NPI:1386293199
Name:CENTRO DE VACUNACION DEL NORTE LLC
Entity type:Organization
Organization Name:CENTRO DE VACUNACION DEL NORTE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENTE
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:
Authorized Official - Last Name:SANTANA OLIVO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-461-9275
Mailing Address - Street 1:R11 CALLE BRISAS
Mailing Address - Street 2:
Mailing Address - City:DORADO
Mailing Address - State:PR
Mailing Address - Zip Code:00646-2160
Mailing Address - Country:US
Mailing Address - Phone:787-461-9275
Mailing Address - Fax:
Practice Address - Street 1:BO SABANA CARR 693 KM 14
Practice Address - Street 2:
Practice Address - City:VEGA ALTA
Practice Address - State:PR
Practice Address - Zip Code:00692
Practice Address - Country:US
Practice Address - Phone:787-461-9275
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-09-05
Last Update Date:2019-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2083P0901XAllopathic & Osteopathic PhysiciansPreventive MedicinePublic Health & General Preventive MedicineGroup - Single Specialty