Healthcare Provider Details

I. General information

NPI: 1962049510
Provider Name (Legal Business Name): CLINICA LAS AMERICAS GUAYNABO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/03/2019
Last Update Date: 09/17/2020
Certification Date: 09/17/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 SABANETAS IND PK
PONCE PR
00716-4401
US

IV. Provider business mailing address

PO BOX 7891
GUAYNABO PR
00970-7891
US

V. Phone/Fax

Practice location:
  • Phone: 787-789-1996
  • Fax:
Mailing address:
  • Phone: 787-789-1996
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: LUIS M MARTINEZ RUIZ
Title or Position: PRESIDENT
Credential: CPA MHSA
Phone: 787-999-3063