Provider Demographics
NPI:1326069220
Name:CLINICA YAGUEZ, INC.
Entity Type:Organization
Organization Name:CLINICA YAGUEZ, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENTE
Authorized Official - Prefix:MR
Authorized Official - First Name:EDUARDO
Authorized Official - Middle Name:JOSE
Authorized Official - Last Name:ARTAU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-832-8444
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:787-832-8444
Mailing Address - Fax:787-805-7440
Practice Address - Street 1:117 CALLE RAMON VALDES
Practice Address - Street 2:
Practice Address - City:MAYAGUEZ
Practice Address - State:PR
Practice Address - Zip Code:00680-3839
Practice Address - Country:US
Practice Address - Phone:787-832-8444
Practice Address - Fax:787-805-7440
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-23
Last Update Date:2020-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR129261QM1300X
PR837291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
No291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR0084907Medicare ID - Type UnspecifiedMULTY SPECIALTY GROUP