Provider Demographics
NPI:1043463789
Name:CLINICAS DE SALUD-EPS
Entity Type:Organization
Organization Name:CLINICAS DE SALUD-EPS
Other - Org Name:PLAN DE PRACTICA INTRAMURAL DE LA ESCUELA DE PROFESIONES D
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:LYVIA
Authorized Official - Middle Name:ALAIDA
Authorized Official - Last Name:ALVAREZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-758-2525
Mailing Address - Street 1:PO BOX 365067
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00936-5067
Mailing Address - Country:US
Mailing Address - Phone:787-758-2525
Mailing Address - Fax:787-758-9831
Practice Address - Street 1:1136 AVE AMERICO MIRANDA
Practice Address - Street 2:REPARTO METROPOLITANO
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00921-2213
Practice Address - Country:US
Practice Address - Phone:787-300-3837
Practice Address - Fax:787-765-0854
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MEDICAL SCIENCES CAMPUS, UNIVERSITY OF PUERTO RICO
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-10-28
Last Update Date:2014-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1592103T00000X
PR579133N00000X
PR326133N00000X
PR1096133N00000X
PR890133N00000X
PR529231H00000X
PR381231H00000X
PR023231H00000X
PR506231H00000X
PR592231H00000X
PR471235Z00000X
PR739235Z00000X
PR472235Z00000X
PR654235Z00000X
PR014235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty
No133N00000XDietary & Nutritional Service ProvidersNutritionistGroup - Multi-Specialty
No231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Multi-Specialty
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR0000000OtherNONE