| Organization Name: | CENTRO VACUNACION IPA 021 |
| NPI Number: | 1275757833 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | VILMA M PADILLA (EXECUTIVE DIRECTOR) |
| Mailing Address: | 72 Calle Arizmendi Florida |
| State: | PR US |
| Postal Code: | 006502006 |
| Phone Number: | 7878223446 |
| Fax Number: | |
| NPI Enumeration Date: | 04/12/2007 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QP2300X |
| License Number: | 2114 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | PR |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Primary Care |
| Taxonomy Definition: | |