Healthcare Provider Details

I. General information

NPI: 1750409389
Provider Name (Legal Business Name): CLINICA CUIDADO MEDICO INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/26/2007
Last Update Date: 02/18/2015
Certification Date:
Deactivation Date: 04/05/2012
Reactivation Date: 02/10/2015

III. Provider practice location address

4 CALLE HOSPITAL
CIALES PR
00638-3310
US

IV. Provider business mailing address

PO BOX 1347
CIALES PR
00638-1347
US

V. Phone/Fax

Practice location:
  • Phone: 787-871-1098
  • Fax: 787-871-4883
Mailing address:
  • Phone: 787-871-1098
  • Fax: 787-871-4883

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number04F1945
License Number StatePR
# 2
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State

VIII. Authorized Official

Name: DR. JORGE D. JIMENEZ
Title or Position: PRESIDENT
Credential: M.D.
Phone: 787-871-1098