Organization
PRUDENTIAL HEALTH NETWORK
Active
Organization subpart
No
Provider details
NPI number
Authorized official
VLADIMIR COSTA (PRESIDENT)
(787) 915-3030
Entity
Organization
Contact information
Practice address
CARR #2 KM 29.7, VEGA ALTA, PR 00692
(787) 915-3030
(787) 915-3033
Mailing address
PO BOX 1652, VEGA ALTA, PR 00692-1652
(787) 915-3030
(787) 915-3033
Taxonomy
Speciality
Code
Description
License number
State
305R00000X
Preferred Provider Organization
Primary
—
—
Other
Enumeration date
10/25/2011
Last updated
10/25/2011
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