Provider Demographics
NPI:1053189126
Name:CENTRO DE VACUNACION ZAIDANIS
Entity type:Organization
Organization Name:CENTRO DE VACUNACION ZAIDANIS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:ENNISS
Authorized Official - Middle Name:
Authorized Official - Last Name:HERNANDEZ MATIAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:939-366-8190
Mailing Address - Street 1:RR 2 BOX 2634
Mailing Address - Street 2:
Mailing Address - City:ANASCO
Mailing Address - State:PR
Mailing Address - Zip Code:00610-9408
Mailing Address - Country:US
Mailing Address - Phone:939-366-8190
Mailing Address - Fax:
Practice Address - Street 1:CARR 402 KM 4.5 BO PINALES
Practice Address - Street 2:
Practice Address - City:ANASCO
Practice Address - State:PR
Practice Address - Zip Code:00610
Practice Address - Country:US
Practice Address - Phone:939-366-8190
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-12-18
Last Update Date:2023-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service