=====================================================
General NPI Number Information
=====================================================
NPI Number | 1174310338
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CLINICA INTEGRATIVA DE MEDICINA Y ACUPUNTURA LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/22/2025
-----------------------------------------------------
Last Update Date | 04/24/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 68 CLL SANTA CRUZ, STE 504 TORRE SAN PABLO
-----------------------------------------------------
City | BAYAMON
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00961
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-225-7416
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | J6 AVE SAN PATRICIO APT 16E
-----------------------------------------------------
City | GUAYNABO
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00968-4426
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-225-7416
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | CARLOS RACHED RICHA
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 787-225-7416
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------