Provider Demographics
NPI:1205132867
Name:DEPARTMENT OF VETERAN AFFAIRS
Entity type:Organization
Organization Name:DEPARTMENT OF VETERAN AFFAIRS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADDICTION THERAPIST
Authorized Official - Prefix:MR
Authorized Official - First Name:FERNANDO
Authorized Official - Middle Name:
Authorized Official - Last Name:CARTAGENA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-812-3030
Mailing Address - Street 1:ST SANTIAGO IGLESIAS
Mailing Address - Street 2:# 4
Mailing Address - City:COAMO
Mailing Address - State:PR
Mailing Address - Zip Code:00769
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1010 PASEO DEL VETERANO
Practice Address - Street 2:
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00716-2001
Practice Address - Country:US
Practice Address - Phone:787-812-3030
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-31
Last Update Date:2011-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QV0200XAmbulatory Health Care FacilitiesClinic/CenterVA