1063055796 NPI number — CLINICA YAGUEZ INC

Table of content: (NPI 1063055796)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1063055796 NPI number — CLINICA YAGUEZ INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CLINICA YAGUEZ 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:
6
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:
1063055796
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/21/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 698
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:
00681-0698
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-832-8444
Provider Business Mailing Address Fax Number:
787-805-2840

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1 CARR 402 ZONA INDUSTRIAL
Provider Second Line Business Practice Location Address:
BO MARIAS
Provider Business Practice Location Address City Name:
ANASCO
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00610-2017
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-832-8444
Provider Business Practice Location Address Fax Number:
787-805-2840
Provider Enumeration Date:
10/25/2019

Additional Information

Authorized Official

Authorized Official Last Name:
HUERTAS
Authorized Official First Name:
CARLOS
Authorized Official Middle Name:
I
Authorized Official Title or Position:
FINANCE DIRECTOR
Authorized Official Telephone Number:
787-832-8444

Provider Taxonomy Codes

  • Taxonomy code: 2085B0100X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: GI092A . This is a "GI092A" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 0084907 . This is a "0084907" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com