Provider Demographics
NPI:1386688000
Name:CLINICA ESPANOLA, INC.
Entity Type:Organization
Organization Name:CLINICA ESPANOLA, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:DR
Authorized Official - First Name:EMIGDIO
Authorized Official - Middle Name:
Authorized Official - Last Name:INIGO
Authorized Official - Suffix:SR
Authorized Official - Credentials:MD
Authorized Official - Phone:787-832-0404
Mailing Address - Street 1:CARRETERA 106 KM 0.5
Mailing Address - Street 2:#1045 CAMINO LA ESPANOLA
Mailing Address - City:MAYAGUEZ
Mailing Address - State:PR
Mailing Address - Zip Code:00680
Mailing Address - Country:US
Mailing Address - Phone:787-832-0404
Mailing Address - Fax:787-832-2094
Practice Address - Street 1:CARRETERA 106 KM 0.5 INTERIOR
Practice Address - Street 2:#1045
Practice Address - City:MAYAGUEZ
Practice Address - State:PR
Practice Address - Zip Code:00680
Practice Address - Country:US
Practice Address - Phone:787-832-0404
Practice Address - Fax:787-832-2094
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-15
Last Update Date:2008-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR51282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR400024Medicare ID - Type Unspecified