Provider Demographics
NPI:1043715287
Name:VIP MEDICAL
Entity type:Organization
Organization Name:VIP MEDICAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:JANIZABETH
Authorized Official - Middle Name:
Authorized Official - Last Name:VAZQUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-554-8129
Mailing Address - Street 1:P.O. BOX 1212
Mailing Address - Street 2:
Mailing Address - City:TOA ALTA
Mailing Address - State:PR
Mailing Address - Zip Code:00954-1212
Mailing Address - Country:US
Mailing Address - Phone:787-870-4704
Mailing Address - Fax:787-870-3756
Practice Address - Street 1:L2 CALLE 7
Practice Address - Street 2:URB SAN FERNANDO
Practice Address - City:TOA ALTA
Practice Address - State:PR
Practice Address - Zip Code:00953
Practice Address - Country:US
Practice Address - Phone:787-870-4704
Practice Address - Fax:787-870-3756
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-29
Last Update Date:2018-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
No261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
No302R00000XManaged Care OrganizationsHealth Maintenance Organization