Healthcare Provider Details

I. General information

NPI: 1134821630
Provider Name (Legal Business Name): CLINICA TODO SALUD - AIBONITO, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/20/2023
Last Update Date: 05/19/2025
Certification Date: 05/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CARR #2 KM 129.5 BO VICTORIA
AGUADILLA PR
00603
US

IV. Provider business mailing address

PO BOX 71114
SAN JUAN PR
00936-8014
US

V. Phone/Fax

Practice location:
  • Phone: 787-545-7073
  • Fax:
Mailing address:
  • Phone: 787-545-7073
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: GLORIA HERNANDEZ
Title or Position: PROVIDER RELATIONSHIP ACCT MANAGER
Credential: MHSA
Phone: 787-622-3000