Healthcare Provider Details

I. General information

NPI: 1316406721
Provider Name (Legal Business Name): CLINICA YAGUEZ, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/15/2019
Last Update Date: 04/21/2020
Certification Date: 04/21/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CARR 116 RAMAL 1116 KM 27.7
GUANICA PR
00653
US

IV. Provider business mailing address

PO BOX 698
MAYAGUEZ PR
00681-0698
US

V. Phone/Fax

Practice location:
  • Phone: 787-821-0402
  • Fax: 787-805-2840
Mailing address:
  • Phone: 787-505-1605
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085B0100X
TaxonomyBody Imaging Physician
License Number
License Number State

VIII. Authorized Official

Name: YAMILA VILLANUEVA
Title or Position: BILLING SUPERVISOR
Credential:
Phone: 787-821-0402