Healthcare Provider Details

I. General information

NPI: 1508577594
Provider Name (Legal Business Name): CLINICA TODO SALUD - AIBONITO, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/09/2022
Last Update Date: 05/14/2025
Certification Date: 05/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

260 BOULEVARD DEL RIO TORRE 1 - BOULEVARD PLAZA OFFICE CENTER
HUMACAO PR
00791
US

IV. Provider business mailing address

PO BOX 71114
SAN JUAN PR
00936-8014
US

V. Phone/Fax

Practice location:
  • Phone: 787-522-2482
  • Fax:
Mailing address:
  • Phone: 787-522-2482
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207QG0300X
TaxonomyGeriatric Medicine (Family Medicine) Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MARCOS AGUILA SASTRE
Title or Position: VP OF CLINICS
Credential: MHSA
Phone: 787-622-3000