Healthcare Provider Details

I. General information

NPI: 1861167124
Provider Name (Legal Business Name): CLINICA SANAMED LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/10/2021
Last Update Date: 08/10/2021
Certification Date: 07/14/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CROWN HILL CALLE CARITE 125 ESQUINA AVE. PARANA, LOCAL #2
SAN JUAN PR
00926
US

IV. Provider business mailing address

562 SUMMIT HILLS CALLE GREENWOOD
SAN JUAN PR
00920-4322
US

V. Phone/Fax

Practice location:
  • Phone: 939-945-8458
  • Fax:
Mailing address:
  • Phone: 939-945-8458
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JORGE MONTALVO
Title or Position: PERSONA AUTORIZADA
Credential: MD
Phone: 787-674-4124