Provider Demographics
| NPI: | 1326096058 |
|---|---|
| Name: | CLINICA LAS AMERICAS GUAYNABO, INC |
| Entity Type: | Organization |
| Organization Name: | CLINICA LAS AMERICAS GUAYNABO, INC |
| Other - Org Name: | SALUS GUAYNABO |
| Other - Org Type: | Doing Business As |
| Authorized Official - Title/Position: | PRESIDENT |
| Authorized Official - Prefix: | |
| Authorized Official - First Name: | LUIS |
| Authorized Official - Middle Name: | M |
| Authorized Official - Last Name: | MARTINEZ RUIZ |
| Authorized Official - Suffix: | |
| Authorized Official - Credentials: | MHSA CPA |
| Authorized Official - Phone: | 787-999-3063 |
| Mailing Address - Street 1: | PO BOX 7891 |
| Mailing Address - Street 2: | PMB 509 |
| Mailing Address - City: | GUAYNABO |
| Mailing Address - State: | PR |
| Mailing Address - Zip Code: | 00970-7891 |
| Mailing Address - Country: | US |
| Mailing Address - Phone: | 787-789-1919 |
| Mailing Address - Fax: | 787-999-3071 |
| Practice Address - Street 1: | CASA LINDA AVE. #1 SUITE 101-ROUTE 177 LOS FILTROS |
| Practice Address - Street 2: | ENTRANCE AMERICAN MILITARY ACADEMY |
| Practice Address - City: | BAYAMON |
| Practice Address - State: | PR |
| Practice Address - Zip Code: | 00959-8998 |
| Practice Address - Country: | US |
| Practice Address - Phone: | 787-789-1919 |
| Practice Address - Fax: | 787-999-3071 |
| EIN: | <UNAVAIL> |
| Is Organization Subpart?: | Yes |
| Parent Organization LBN: | CLINICA LAS AMERICAS GUAYNABO |
| Parent Organization TIN: | <UNAVAIL> |
| Enumeration Date: | 2006-05-05 |
| Last Update Date: | 2020-08-11 |
| Deactivation Date: | |
| Deactivation Code: | |
| Reactivation Date: |
Provider Licenses
| State | License ID | Taxonomies |
|---|---|---|
| 103TC0700X, 133N00000X, 207K00000X, 207N00000X, 207RE0101X, 207RG0100X, 207RH0003X, 207RP1001X, 207RR0500X, 207V00000X, 207VF0040X, 2085R0202X, 2086X0206X, 231H00000X | ||
| PR | 261QM1300X |
Provider Taxonomies
| Primary? | Code | Type | Classification | Specialization | Group |
|---|---|---|---|---|---|
| Yes | 261QM1300X | Ambulatory Health Care Facilities | Clinic/Center | Multi-Specialty | Group - Multi-Specialty |
| No | 103TC0700X | Behavioral Health & Social Service Providers | Psychologist | Clinical | Group - Multi-Specialty |
| No | 133N00000X | Dietary & Nutritional Service Providers | Nutritionist | Group - Multi-Specialty | |
| No | 207K00000X | Allopathic & Osteopathic Physicians | Allergy & Immunology | Group - Multi-Specialty | |
| No | 207N00000X | Allopathic & Osteopathic Physicians | Dermatology | Group - Multi-Specialty | |
| No | 207RE0101X | Allopathic & Osteopathic Physicians | Internal Medicine | Endocrinology, Diabetes & Metabolism | Group - Multi-Specialty |
| No | 207RG0100X | Allopathic & Osteopathic Physicians | Internal Medicine | Gastroenterology | Group - Multi-Specialty |
| No | 207RH0003X | Allopathic & Osteopathic Physicians | Internal Medicine | Hematology & Oncology | Group - Multi-Specialty |
| No | 207RP1001X | Allopathic & Osteopathic Physicians | Internal Medicine | Pulmonary Disease | Group - Multi-Specialty |
| No | 207RR0500X | Allopathic & Osteopathic Physicians | Internal Medicine | Rheumatology | Group - Multi-Specialty |
| No | 207V00000X | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | Group - Multi-Specialty | |
| No | 207VF0040X | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | Female Pelvic Medicine and Reconstructive Surgery | Group - Multi-Specialty |
| No | 2085R0202X | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology | Group - Multi-Specialty |
| No | 2086X0206X | Allopathic & Osteopathic Physicians | Surgery | Surgical Oncology | Group - Multi-Specialty |
| No | 231H00000X | Speech, Language and Hearing Service Providers | Audiologist | Group - Multi-Specialty |
Provider Identifiers
| State | Identifier ID | ID Type | Issuer |
|---|---|---|---|
| PR | 0090289 | Medicare PIN |
