Provider Demographics
NPI:1649501800
Name:ERNESTO MUNOZ VILCHES C.S.P.
Entity type:Organization
Organization Name:ERNESTO MUNOZ VILCHES C.S.P.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ERNESTO
Authorized Official - Middle Name:JOAQUIN
Authorized Official - Last Name:MUNOZ VILCHES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-630-4060
Mailing Address - Street 1:PMB 270
Mailing Address - Street 2:PO BOX 4956
Mailing Address - City:CAGUAS
Mailing Address - State:PR
Mailing Address - Zip Code:00726-4956
Mailing Address - Country:US
Mailing Address - Phone:787-630-4060
Mailing Address - Fax:787-721-8448
Practice Address - Street 1:WASHIGNTON #29 ASHFORD MEDICAL CENTER
Practice Address - Street 2:SUITE 208 -B
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00907
Practice Address - Country:US
Practice Address - Phone:787-721-4836
Practice Address - Fax:787-721-8448
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-27
Last Update Date:2010-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR11412261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR008-4307Medicare UPIN
PR1861436461Medicare PIN