Healthcare Provider Details

I. General information

NPI: 1326069220
Provider Name (Legal Business Name): CLINICA YAGUEZ, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/23/2006
Last Update Date: 04/21/2020
Certification Date: 04/21/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

117 CALLE RAMON VALDES
MAYAGUEZ PR
00680-3839
US

IV. Provider business mailing address

PO BOX 698
MAYAGUEZ PR
00681-0698
US

V. Phone/Fax

Practice location:
  • Phone: 787-832-8444
  • Fax: 787-805-7440
Mailing address:
  • Phone: 787-832-8444
  • Fax: 787-805-7440

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number129
License Number StatePR
# 2
Primary TaxonomyN
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number837
License Number StatePR

VIII. Authorized Official

Name: MR. EDUARDO JOSE ARTAU
Title or Position: PRESIDENTE
Credential:
Phone: 787-832-8444