Provider Demographics
NPI:1154334548
Name:CLA RADIO SURGERY GROUP INC.
Entity Type:Organization
Organization Name:CLA RADIO SURGERY GROUP INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RICARDO
Authorized Official - Middle Name:H
Authorized Official - Last Name:BRAU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-753-9624
Mailing Address - Street 1:400 AVE FD ROOSEVELT
Mailing Address - Street 2:SUITE 305
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00918-2103
Mailing Address - Country:US
Mailing Address - Phone:787-753-9624
Mailing Address - Fax:787-753-9625
Practice Address - Street 1:400 AVE FD ROOSEVELT
Practice Address - Street 2:SUITE 305
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00918-2103
Practice Address - Country:US
Practice Address - Phone:787-753-9624
Practice Address - Fax:787-753-9625
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QX0203XAmbulatory Health Care FacilitiesClinic/CenterOncology, Radiation
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR=========OtherEMPLOYER ID NUMBER