1538617279 NPI number — CLINICA YAGUEZ, INC

Table of content: (NPI 1538617279)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1538617279 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:
CENTRO RADIOLOGICO CLINICA YAGUEZ
Provider Other Organization Name Type Code:
3
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:
1538617279
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:
787-832-8445
Provider Business Mailing Address Fax Number:
787-805-2840

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
117 SUR CALLE RAMON VALDEZ
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MAYAGUEZ
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00680
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-832-8445
Provider Business Practice Location Address Fax Number:
787-805-2840
Provider Enumeration Date:
09/12/2016

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:
787-832-8445

Provider Taxonomy Codes

  • Taxonomy code: 174400000X , with the licence number:  129 , 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)