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Organization
VIDALUS LLC
Active
Organization
VIDALUS LLC
Active
Other names
Vidalus LLC
Organization subpart
No
Provider details
NPI number
Authorized official
MR. MARK C BLACKBURN (MANAGER)
(561) 578-1730
Entity
Organization
Contact information
Practice address
677 CALLE FELIPE GUTIERREZ, SAN JUAN, PR 00924-2207
(561) 578-1730
Mailing address
31 HARBOUR LIGHTS DR, HUMACAO, PR 00791-6055
(561) 578-1730
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
Primary
—
NULL
Other
Enumeration date
08/04/2022
Last updated
10/18/2024
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