1306830088 NPI number — CLINICA ESPANOLA INC

Table of content: (NPI 1306830088)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1306830088 NPI number — CLINICA ESPANOLA INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CLINICA ESPANOLA INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
LA ESPANOLA HOME HEALTH AGENCY
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1306830088
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/15/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 490
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MAYAGUEZ
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00681-0490
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-834-3941
Provider Business Mailing Address Fax Number:
787-832-2094

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1045 CAMINO LA ESPANOLA
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MAYAQUEZ
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00680-1045
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-831-3941
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/08/2005

Additional Information

Authorized Official

Authorized Official Last Name:
ARROYO
Authorized Official First Name:
MARIBEL
Authorized Official Middle Name:
Authorized Official Title or Position:
DIRECTOR OF THERAPUTIC SERVICES
Authorized Official Telephone Number:
787-834-3941

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X , with the licence number:  17 CNC 8602 , registered in the state of PR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 50793 . This is a "PMC MEDICARE CHOICE" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 830014 . This is a "MMM HEALTH CARE" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".




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