| Vidasana Family Practice Llc | |
|
592 Calle Cesar Gonzalez Apt 711 San Juan PR 00918-3957 | |
| (787) 515-7316 | |
| Not Available |
| Full Name | Vidasana Family Practice Llc |
|---|---|
| Speciality | Family Medicine |
| Location | 592 Calle Cesar Gonzalez Apt 711, San Juan, Puerto Rico |
| Authorized Official Name and Position | Luis Antonio Lopez Perez (PRESIDENT/PHYSICIAN) |
| Authorized Official Contact | 7875157316 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Vidasana Family Practice Llc 592 Calle Cesar Gonzalez Apt 711 San Juan PR 00918-3957 Ph: (787) 515-7316 | Vidasana Family Practice Llc 592 Calle Cesar Gonzalez Apt 711 San Juan PR 00918-3957 Ph: (787) 515-7316 |
| NPI Number | 1922787621 |
|---|---|
| Provider Enumeration Date | 07/12/2023 |
| Last Update Date | 07/12/2023 |
| Medicare PECOS PAC ID | 8729441480 |
|---|---|
| Medicare Enrollment ID | O20230828003284 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1922787621 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| Provider Name | Luis Antonio Lopez Perez |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1477025591 PECOS PAC ID: 5395114060 Enrollment ID: I20221220001377 |
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