1033508197 NPI number — CLINICA LAS AMERICAS GUAYNABO, INC

Table of content: (NPI 1033508197)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1033508197 NPI number — CLINICA LAS AMERICAS GUAYNABO, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CLINICA LAS AMERICAS GUAYNABO, 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:
Provider Other Organization Name Type Code:
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:
1033508197
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/12/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 7891
Provider Second Line Business Mailing Address:
PMB 509
Provider Business Mailing Address City Name:
GUAYNABO
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00970-7894
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-789-1919
Provider Business Mailing Address Fax Number:
787-999-3069

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
#1 CASA LINDA AVE. SUITE 101 ROUTE 177 LOS FILTROS
Provider Second Line Business Practice Location Address:
ENTRANCE AMERICAN MILITARY ACADEMY
Provider Business Practice Location Address City Name:
BAYAMON
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00959
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-789-1919
Provider Business Practice Location Address Fax Number:
787-999-3069
Provider Enumeration Date:
01/13/2015

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
MARTINEZ RUIZ
Authorized Official First Name:
LUIS
Authorized Official Middle Name:
M
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
787-999-3063

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207R00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RG0300X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208D00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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