Healthcare Provider Details

I. General information

NPI: 1003033747
Provider Name (Legal Business Name): CLINICA LAS AMERICAS GUAYNABO, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/20/2007
Last Update Date: 04/22/2025
Certification Date: 04/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CASA LINA AVE. #1 SUITE 101 1 AVE CASA LINDA
BAYAMON PR
00969-9000
US

IV. Provider business mailing address

PMB 509 P.O.BOX 7891
GUAYNABO PR
00970-7891
US

V. Phone/Fax

Practice location:
  • Phone: 787-789-1996
  • Fax: 787-789-2180
Mailing address:
  • Phone: 787-789-1919
  • Fax: 787-789-1921

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number
License Number State

VIII. Authorized Official

Name: NURY TOLEDO NUNEZ
Title or Position: SVP & PHARMACY STRATEGY
Credential:
Phone: 787-789-1996