Provider Demographics
NPI:1033508197
Name:CLINICA LAS AMERICAS GUAYNABO, INC
Entity Type:Organization
Organization Name:CLINICA LAS AMERICAS GUAYNABO, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LUIS
Authorized Official - Middle Name:M
Authorized Official - Last Name:MARTINEZ RUIZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-999-3063
Mailing Address - Street 1:PO BOX 7891
Mailing Address - Street 2:PMB 509
Mailing Address - City:GUAYNABO
Mailing Address - State:PR
Mailing Address - Zip Code:00970-7894
Mailing Address - Country:US
Mailing Address - Phone:787-789-1919
Mailing Address - Fax:787-999-3069
Practice Address - Street 1:#1 CASA LINDA AVE. SUITE 101 ROUTE 177 LOS FILTROS
Practice Address - Street 2:ENTRANCE AMERICAN MILITARY ACADEMY
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00959
Practice Address - Country:US
Practice Address - Phone:787-789-1919
Practice Address - Fax:787-999-3069
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-13
Last Update Date:2018-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR90289Medicare PIN