Healthcare Provider Details

I. General information

NPI: 1912656125
Provider Name (Legal Business Name): CLINICA LAS MERCEDES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/23/2022
Last Update Date: 02/26/2025
Certification Date: 02/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

450 SW 136TH AVE
PEMBROKE PINES FL
33027-6073
US

IV. Provider business mailing address

6355 NW 36TH ST BLDG STE 1100
VIRGINIA GARDENS FL
33166-7009
US

V. Phone/Fax

Practice location:
  • Phone: 954-239-4818
  • Fax: 954-751-5044
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