| NAME |
MAYAGUEZ |
| STATE |
PUERTO RICO |
| STREET ADDR. 1 |
345 HOSTOS AVENUE |
| CITY |
MAYAGUEZ |
| ZIP |
00680-1507 |
| OFFICIAL VA NAME |
MAYAGUEZ OUTPATIENT CLINIC |
| STATUS |
National |
| ASSOCIATIONS |
|
| BILLING FACILITY NAME |
MAYAGUEZ VA CLINIC |
| ST. ADDR. 1 (MAILING) |
345 HOSTOS AVENUE |
| CITY (MAILING) |
MAYAGUEZ |
| STATE (MAILING) |
PUERTO RICO |
| ZIP (MAILING) |
00680-1507 |
| EFFECTIVE DATE/TIME |
-
- 2007-01-08 00:00:00
- STATUS: ACTIVE
- NPI: 1184662843
|
| TAXONOMY CODE |
|
| LOCATION TIMEZONE |
ATLANTIC |
| COUNTRY |
USA |
| TIMEZONE EXCEPTION |
SST Only |
| AGENCY CODE |
VA |
| POINTER TO AGENCY |
VA |
| STATION NUMBER |
672BZ |
| IDENTIFIER |
-
- CODING SYSTEM: NPI
- ID: 1184662843
-
- CODING SYSTEM: VASTANUM
- ID: 672BZ
-
- CODING SYSTEM: CLIA
- ID: 40D0987714
|
