Healthcare Provider Details

I. General information

NPI: 1144868589
Provider Name (Legal Business Name): CLINICA LAS MERCEDES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/17/2019
Last Update Date: 02/26/2025
Certification Date: 02/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8251 W BROWARD BLVD STE 200-210
PLANTATION FL
33324-2703
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: 954-334-3131
  • Fax: 954-334-3132
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 Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

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