1427667047 NPI number — CLINICA TODO SALUD - AIBONITO, LLC

Table of content: (NPI 1861531170)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1427667047 NPI number — CLINICA TODO SALUD - AIBONITO, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CLINICA TODO SALUD - AIBONITO, LLC
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:
CLINICA TODO SALUD - LABORATORIO CLINICO
Provider Other Organization Name Type Code:
5
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:
1427667047
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/23/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 71114
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAN JUAN, PR
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00936-8014
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-622-3000
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
CARR 725 KM 0.5 BO LLANOS
Provider Second Line Business Practice Location Address:
PARQUE INDUSTRIAL L-238-0-61
Provider Business Practice Location Address City Name:
AIBONITO
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00705-3526
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-545-7073
Provider Business Practice Location Address Fax Number:
787-620-5379
Provider Enumeration Date:
07/29/2020

Additional Information

Authorized Official

Authorized Official Last Name:
PEREZ FELIX
Authorized Official First Name:
SHEILLY
Authorized Official Middle Name:
D
Authorized Official Title or Position:
PRACTICE MANAGER
Authorized Official Telephone Number:
787-545-7073

Provider Taxonomy Codes

  • Taxonomy code: 291U00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1421 . This is a "SARAF - LABORATORY" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 40D2263629 . This is a "CLIA" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".




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