Provider Demographics
NPI:1093038465
Name:CLINICA DR BAGUE
Entity Type:Organization
Organization Name:CLINICA DR BAGUE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ISMAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:BAGUE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-614-0494
Mailing Address - Street 1:PO BOX 1389
Mailing Address - Street 2:
Mailing Address - City:HATILLO
Mailing Address - State:PR
Mailing Address - Zip Code:00659-1389
Mailing Address - Country:US
Mailing Address - Phone:787-878-0948
Mailing Address - Fax:787-815-5810
Practice Address - Street 1:CARR 681 KM 4.4
Practice Address - Street 2:ISLOTE
Practice Address - City:ARECIBO
Practice Address - State:PR
Practice Address - Zip Code:00612-0000
Practice Address - Country:US
Practice Address - Phone:787-878-0948
Practice Address - Fax:787-815-5810
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-12
Last Update Date:2010-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR12943146D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes146D00000XEmergency Medical Service ProvidersPersonal Emergency Response AttendantGroup - Multi-Specialty