Provider Demographics
NPI:1326681065
Name:CLINICA YAGUEZ INC
Entity Type:Organization
Organization Name:CLINICA YAGUEZ INC
Other - Org Name:LABORATORIO PAVIA HEALTH CLINIC ANASCO
Other - Org Type:Doing Business As
Authorized Official - Title/Position:FINANCE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:CARLOS
Authorized Official - Middle Name:I
Authorized Official - Last Name:HUERTAS
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:787-805-2840
Practice Address - Street 1:1 CARR 402 ZONA INDUSTRIAL
Practice Address - Street 2:BO MARIAS
Practice Address - City:ANASCO
Practice Address - State:PR
Practice Address - Zip Code:00610-2017
Practice Address - Country:US
Practice Address - Phone:787-832-8444
Practice Address - Fax:787-805-2840
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-25
Last Update Date:2020-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRGI092AOtherGI092A