Healthcare Provider Details

I. General information

NPI: 1316753478
Provider Name (Legal Business Name): CLINICA LAS MERCEDES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/04/2024
Last Update Date: 02/26/2025
Certification Date: 02/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2740 HOLLYWOOD BLVD
HOLLYWOOD FL
33020-4808
US

IV. Provider business mailing address

6355 NW 36TH ST STE 1100
VIRGINIA GARDENS FL
33166-7059
US

V. Phone/Fax

Practice location:
  • Phone: 954-334-3124
  • Fax: 954-637-0986
Mailing address:
  • Phone: 786-233-6981
  • Fax: 786-322-2317

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

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