Healthcare Provider Details

I. General information

NPI: 1043463789
Provider Name (Legal Business Name): CLINICAS DE SALUD-EPS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/28/2008
Last Update Date: 02/26/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1136 AVE AMERICO MIRANDA REPARTO METROPOLITANO
SAN JUAN PR
00921-2213
US

IV. Provider business mailing address

PO BOX 365067
SAN JUAN PR
00936-5067
US

V. Phone/Fax

Practice location:
  • Phone: 787-300-3837
  • Fax: 787-765-0854
Mailing address:
  • Phone: 787-758-2525
  • Fax: 787-758-9831

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133N00000X
TaxonomyNutritionist
License Number579
License Number StatePR
# 2
Primary TaxonomyN
Taxonomy Code133N00000X
TaxonomyNutritionist
License Number326
License Number StatePR
# 3
Primary TaxonomyN
Taxonomy Code133N00000X
TaxonomyNutritionist
License Number1096
License Number StatePR
# 4
Primary TaxonomyN
Taxonomy Code133N00000X
TaxonomyNutritionist
License Number890
License Number StatePR
# 5
Primary TaxonomyN
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number529
License Number StatePR
# 6
Primary TaxonomyN
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number381
License Number StatePR
# 7
Primary TaxonomyN
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number023
License Number StatePR
# 8
Primary TaxonomyN
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number506
License Number StatePR
# 9
Primary TaxonomyN
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number592
License Number StatePR
# 10
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number471
License Number StatePR
# 11
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number739
License Number StatePR
# 12
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number472
License Number StatePR
# 13
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number654
License Number StatePR
# 14
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number014
License Number StatePR
# 15
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number1592
License Number StatePR

VIII. Authorized Official

Name: DR. LYVIA ALAIDA ALVAREZ
Title or Position: EXECUTIVE DIRECTOR
Credential: MD
Phone: 787-758-2525