Healthcare Provider Details

I. General information

NPI: 1376018804
Provider Name (Legal Business Name): CLINICA LAS MERCEDES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/11/2018
Last Update Date: 02/26/2025
Certification Date: 02/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

149 WEST 21ST STREET
HIALEAH FL
33010
US

IV. Provider business mailing address

6355 NW 36TH ST EAST BUILDING, STE 1100
VIRGINIA GARDENS FL
33166
US

V. Phone/Fax

Practice location:
  • Phone: 786-453-8720
  • Fax: 786-219-4355
Mailing address:
  • Phone: 786-233-6981
  • Fax: 786-322-2317

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: JORGE RAAD
Title or Position: AUTHORIZED OFFICIAL
Credential:
Phone: 786-233-6981