Healthcare Provider Details

I. General information

NPI: 1205227220
Provider Name (Legal Business Name): CONSOLIDATED MEDICAL CLINIC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/12/2015
Last Update Date: 07/29/2025
Certification Date: 07/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CONSOLIDATED MALL C-20 AVENIDA GAUTIER BENITEZ 202
CAGUAS PR
00726-6330
US

IV. Provider business mailing address

PO BOX 6330
CAGUAS PR
00726-6330
US

V. Phone/Fax

Practice location:
  • Phone: 787-745-5050
  • Fax: 787-746-6784
Mailing address:
  • Phone: 787-745-5050
  • Fax: 787-746-6784

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number132193
License Number StatePR
# 3
Primary TaxonomyN
Taxonomy Code261QC1500X
TaxonomyCommunity Health Clinic/Center
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code261QR0200X
TaxonomyRadiology Clinic/Center
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code261QR0206X
TaxonomyMammography Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: SALVADOR CARRION DE LEON
Title or Position: PRESIDENT
Credential: MD
Phone: 787-745-5050