Provider Demographics
NPI:1316406721
Name:CLINICA YAGUEZ, INC
Entity Type:Organization
Organization Name:CLINICA YAGUEZ, INC
Other - Org Name:CENTRO RADIOLOGICO PAVIA HEALTH CLINIC GUANICA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BILLING SUPERVISOR
Authorized Official - Prefix:
Authorized Official - First Name:YAMILA
Authorized Official - Middle Name:
Authorized Official - Last Name:VILLANUEVA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-821-0402
Mailing Address - Street 1:PO BOX 698
Mailing Address - Street 2:
Mailing Address - City:MAYAGUEZ
Mailing Address - State:PR
Mailing Address - Zip Code:00681-0698
Mailing Address - Country:US
Mailing Address - Phone:787-505-1605
Mailing Address - Fax:
Practice Address - Street 1:CARR 116 RAMAL 1116 KM 27.7
Practice Address - Street 2:
Practice Address - City:GUANICA
Practice Address - State:PR
Practice Address - Zip Code:00653
Practice Address - Country:US
Practice Address - Phone:787-821-0402
Practice Address - Fax:787-805-2840
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-15
Last Update Date:2020-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085B0100XAllopathic & Osteopathic PhysiciansRadiologyBody ImagingGroup - Single Specialty