Healthcare Provider Details

I. General information

NPI: 1518673565
Provider Name (Legal Business Name): CLINICA LAS MERCEDES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/24/2023
Last Update Date: 04/18/2024
Certification Date: 04/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6674 NW 57TH ST
TAMARAC FL
33319-2107
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: 954-334-3121
  • Fax: 954-637-1043
Mailing address:
  • Phone: 786-233-6981
  • Fax: 786-322-2317

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
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