Healthcare Provider Details

I. General information

NPI: 1326665241
Provider Name (Legal Business Name): CLINICA TODO SALUD - CAGUAS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/26/2020
Last Update Date: 06/30/2020
Certification Date: 06/30/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

350 AVE. CHARDON SUITE 500, TORRE CHARDON
SAN JUAN PR
00936-8014
US

IV. Provider business mailing address

PO BOX 71114
SAN JUAN PR
00936-8014
US

V. Phone/Fax

Practice location:
  • Phone: 787-622-3000
  • Fax:
Mailing address:
  • Phone: 787-622-3000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QR0206X
TaxonomyMammography Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QR0200X
TaxonomyRadiology Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MRS. MIRELLA M BAEZ
Title or Position: AVP COMMUNITY BASED SERVICES
Credential: MSW
Phone: 787-622-3000