1912970351 NPI number — LOS ANGELES MEDICAL CLINIC CORP

Table of content: (NPI 1912970351)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1912970351 NPI number — LOS ANGELES MEDICAL CLINIC CORP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LOS ANGELES MEDICAL CLINIC CORP
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:
1912970351
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/17/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1400 CALLE SAN RAFAEL
Provider Second Line Business Mailing Address:
ESQ HIPODROMO SUITE 201
Provider Business Mailing Address City Name:
SAN JUAN
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00909-2693
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-721-6626
Provider Business Mailing Address Fax Number:
787-725-1287

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1400 CALLE SAN RAFAEL
Provider Second Line Business Practice Location Address:
ESQ HIPODROMO SUITE 201
Provider Business Practice Location Address City Name:
SANTURCE
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00909-2644
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-721-6626
Provider Business Practice Location Address Fax Number:
787-725-1287
Provider Enumeration Date:
02/08/2006

Additional Information

Authorized Official

Authorized Official Last Name:
SAEZ
Authorized Official First Name:
MYRIAM
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
787-721-0429

Provider Taxonomy Codes

  • Taxonomy code: 103TC0700X , with the licence number:  70 , registered in the state of PR ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 103TC0700X , with the licence number: 1820 , registered in the state of PR ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207Q00000X , with the licence number: 013924 , registered in the state of PR ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207Q00000X , with the licence number: 11058 , registered in the state of PR ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207R00000X , with the licence number: 9251 , registered in the state of PR ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RC0000X , with the licence number: 4847 , registered in the state of PR ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RP1001X , with the licence number: 8908 , registered in the state of PR ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207V00000X , with the licence number: 10561 , registered in the state of PR ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208100000X , with the licence number: 15909 , registered in the state of PR ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208D00000X , with the licence number: 16341 , registered in the state of PR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 208D00000X , with the licence number: 16296 , registered in the state of PR ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 225100000X , with the licence number: 624 , registered in the state of PR ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 4172 . This is a "PMC" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 9090182 . This is a "HUMANA" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 3153261 . This is a "UIA" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 04486 . This is a "AMERICAN HEALTH INC" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 9080048 . This is a "HUMANA" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 3842 . This is a "AMERICAN HEALTH MEDICARE" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 4965 . This is a "PALI" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".




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