| Vidalus LLC | |
|
677 Calle Felipe Gutierrez San Juan PR 00924-2207 | |
| (561) 578-1730 | |
| Not Available |
| Full Name | Vidalus LLC |
|---|---|
| Speciality | Clinic/Center |
| Location | 677 Calle Felipe Gutierrez, San Juan, Puerto Rico |
| Authorized Official Name and Position | Mark C Blackburn (MANAGER) |
| Authorized Official Contact | 5615781730 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Vidalus LLC 31 Harbour Lights Dr Humacao PR 00791-6055 Ph: (561) 578-1730 | Vidalus LLC 677 Calle Felipe Gutierrez San Juan PR 00924-2207 Ph: (561) 578-1730 |
| NPI Number | 1699402255 |
|---|---|
| Provider Enumeration Date | 08/04/2022 |
| Last Update Date | 10/18/2024 |
| Certification Date | 10/18/2024 |
| Medicare PECOS PAC ID | 1254717812 |
|---|---|
| Medicare Enrollment ID | O20221005000525 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1699402255 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | () | Primary |
| Provider Name | Nayraliz Colon-nieves |
|---|---|
| Provider Type | Practitioner - General Practice |
| Provider Identifiers | NPI Number: 1013148097 PECOS PAC ID: 2860822111 Enrollment ID: I20200429000124 |
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