1104347491 NPI number — CLINICA LAS AMERICAS GUAYNABO, INC

Table of content: (NPI 1104347491)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1104347491 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:
1104347491
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/23/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 2010
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CAROLINA
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00984-2010
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-789-1919
Provider Business Mailing Address Fax Number:
787-789-2180

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
CARR. 190 KM1.8
Provider Second Line Business Practice Location Address:
BARRIO SABANA ABAJO
Provider Business Practice Location Address City Name:
CAROLINA
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00983-7401
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-789-1996
Provider Business Practice Location Address Fax Number:
787-789-2180
Provider Enumeration Date:
06/28/2017

Additional Information

Authorized Official

Authorized Official Last Name:
TOLEDO NUNEZ
Authorized Official First Name:
NURY
Authorized Official Middle Name:
Authorized Official Title or Position:
SVP & STRATEGY PHARMACY
Authorized Official Telephone Number:
787-789-1996

Provider Taxonomy Codes

  • Taxonomy code: 2083P0500X , 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: 4035918 . This is a "PREVENTIVE PROGRAM AT ANOTHER LOCATION" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".




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